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Abstract：
Aim To study the clinical profile and course and to assess the outcome of patients with biopsy-proven primary membranous nephropathy (MN). Methods This study was carried out in a tertiary care hospital between December 2017 and December 2021 on four-year retrospective biopsy-proven patients with membranous nephropathy (MN). Urinary proteins, serum albumin, and serum creatinine were the baseline investigations that were performed. Special tests were done whenever necessary. Patients were treated with a modified Ponticelli (MP) regimen whenever needed. Patients were followed up after treatment administration for a minimum of a year. Results The study was done in 48 biopsy-proven MN patients. Thirty-six patients had primary MN with a mean age of 47+/-11.7 years. The male-female ratio was 2.6:1. Hypertension was present in 39% (14 patients), microscopic hematuria in 28% (10 patients), and acute kidney injury in 22% (8 patients). The mean 24-hour urinary protein was 11.2+/-2.9 g/day. PLA2R was positive in 78% (28 patients) of primary MN patients. Spontaneous remission was noted in 13.8% (5 patients) who were treated conservatively. Spontaneous remission was associated with lower baseline proteinuria (p<0.001), higher baseline serum albumin (p<0.001), and PLA2R negativity (p=0.04). Complete or partial treatment response was noted in 74.2% (23 patients). Treatment remission was associated with lower baseline proteinuria (p=0.018). Secondary membranous nephropathy (secondary MN) was diagnosed in 12 patients. Eleven were class V lupus nephritis, all women, and one male person living with HIV/AIDS (PLHA). Conclusions The majority of our primary MN patients were PLA2R positive on renal biopsy. Statistically significant factors associated with spontaneous remission were lower proteinuria, higher serum albumin at baseline, and PLA2R negativity. Treatment response was associated with lower proteinuria at presentation. The most common cause of secondary MN was lupus nephritis.
摘要：
目的研究经活检证实的原发性膜性肾病（MN）的临床特征和病程，并评估其预后。方法本研究于2017年12月至2021年12月在某三甲医院对经4年回顾性活检证实的膜性肾病(MN)患者进行。尿蛋白,血清白蛋白,和血清肌酐是进行的基线研究.必要时进行特殊测试。患者在需要时接受改良的Ponticelli（MP）方案治疗。患者在治疗后至少随访一年。结果本研究在48例经活检证实的MN患者中进行。36名患者患有原发性MN，平均年龄为47+/-11.7岁。男女比例为2.6：1。39％（14名患者）存在高血压，28％（10例）镜下血尿，22％（8例）的急性肾损伤。平均24小时尿蛋白为11.2+/-2.9g/天。78％（28例）的原发性MN患者中PLA2R为阳性。保守治疗的13.8％（5例）自发缓解。自发缓解与较低基线蛋白尿相关(p<0.001),较高的基线血清白蛋白（p<0.001），和PLA2R负性(p=0.04)。74.2%（23例）有完全或部分治疗反应。治疗缓解与较低的基线蛋白尿相关（p=0.018）。12例患者诊断为继发性膜性肾病（继发性MN）。11人是V类狼疮性肾炎,所有的女人,一名男性艾滋病毒/艾滋病患者（PLHA）。结论大多数原发性MN患者在肾活检中PLA2R阳性。与自发缓解相关的统计学显著因素是较低的蛋白尿，基线时血清白蛋白较高，和PLA2R消极。治疗反应与出现时蛋白尿降低相关。继发性MN的最常见原因是狼疮性肾炎。
