Document Type : Research articles

Authors

Department of Nephrology, the Second Hospital of Jilin University, Jilin, China

Abstract

Background: The prevalence of Idiopathic Membranous Nephropathy (IMN) among patients with Primary Glomerular Disease (PGD) has increased in China.
Objectives: This cross-sectional study aimed to investigate changes in the clinicopathological features associated with IMN in northeast China.
Methods: We analyzed clinical and pathological data of 1,198 patients with IMN among 4,083 patients hospitalized with PGD undergoing renal biopsy from January 1, 2005, to December 31, 2018 at the Second Hospital of Jilin University in northeast China. Enrollees were divided into two groups: those seen from 2005 to 2011 (Group 1) and those seen from 2012 to 2018 (Group 2). We compared the clinicopathological features between Group 1 and Group 2.
Results: The percentage of patients with IMN among those with PGD increased over the 14 years of the study (P = 0.001). The male-to-female ratio, prevalence of microscopic hematuria, and proteinuria levels were higher in Group 2 than in Group 1 (P < 0.05). Among those with PGD, the percentages of patients with IMN-total, IMN-I, IMN-II, and IMN-III+IV, as well as Tubulointerstitial Lesion (TIL) scores, were higher in Group 2 than in Group 1 (P < 0.05). Finally, age (P < 0.001), degree of proteinuria (P < 0.001), and serum triglyceride level (P = 0.027) were significantly associated with TIL scores among patients with IMN.
Conclusions: Membranous nephropathy is now the leading cause of PGD, with increased TIL scores during the study period. Advanced age, high proteinuria, and serum triglyceride levels represent the independent risk factors for severe TIL among patients with IMN.

Keywords

  1. Couser WG. Primary Membranous Nephropathy. Clin J Am Soc Nephrol. 2017;12(6):983-97. doi: 10.2215/CJN.11761116. [PubMed: 28550082]. [PubMed Central: PMC5460716].
  2. Hanko JB, Mullan RN, O'Rourke DM, McNamee PT, Maxwell AP, Courtney AE. The changing pattern of adult primary glomerular disease. Nephrol Dial Transplant. 2009;24(10):3050-4. doi: 10.1093/ndt/gfp254. [PubMed: 19487734].
  3. Braden GL, Mulhern JG, O'Shea MH, Nash SV, Ucci AA. Changing incidence of glomerular diseases in adults. Am J Kidney Dis. 2000;35(5):878-83. [PubMed: 10793022].
  4. Xu X, Wang G, Chen N, Lu T, Nie S, Xu G, et al. Long-Term Exposure to Air Pollution and Increased Risk of Membranous Nephropathy in China. J Am Soc Nephrol. 2016;27(12):3739-46. doi: 10.1681/ASN.2016010093. [PubMed: 27365535]. [PubMed Central: PMC5118492].
  5. Pan X, Xu J, Ren H, Zhang W, Xu Y, Shen P, et al. Changing spectrum of biopsy-proven primary glomerular diseases over the past 15 years: a single-center study in China. Contrib Nephrol. 2013;181:22-30. doi: 10.1159/000348638. [PubMed: 23689564].
  6. Zhang X, Liu S, Tang L, Wu J, Chen P, Yin Z, et al. Analysis of pathological data of renal biopsy at one single center in China from 1987 to 2012. Chin Med J (Engl). 2014;127(9):1715-20. [PubMed: 24791880].
  7. Zhu P, Zhou F, Wang S, Zhao M, Wang H. Increasing frequency of idiopathic membranous nephropathy in primary glomerular disease: A 10-year renal biopsy study from a single Chinese nephrology centre. Nephrology. 2015;20(8):560-6. doi: 10.1111/nep.12542.
  8. Tang L, Yao J, Kong X, Sun Q, Wang Z, Zhang Y, et al. Increasing prevalence of membranous nephropathy in patients with primary glomerular diseases: A cross-sectional study in China. Nephrology (Carlton). 2017;22(2):168-73. doi: 10.1111/nep.12739. [PubMed: 26854278].
  9. Zhou Q, Yang X, Wang M, Wang H, Zhao J, Bi Y, et al. Changes in the diagnosis of glomerular diseases in east China: a 15-year renal biopsy study. Ren Fail. 2018;40(1):657-64. doi: 10.1080/0886022X.2018.1537930. [PubMed: 30484732]. [PubMed Central: PMC6282433].
  10. Nie P, Chen R, Luo M, Dong C, Chen L, Liu J, et al. Clinical and Pathological Analysis of 4910 Patients Who Received Renal Biopsies at a Single Center in Northeast China. Biomed Res Int. 2019;2019:6869179. doi: 10.1155/2019/6869179. [PubMed: 31032355]. [PubMed Central: PMC6457280].
  11. Troyanov S, Roasio L, Pandes M, Herzenberg AM, Cattran DC. Renal pathology in idiopathic membranous nephropathy: a new perspective. Kidney Int. 2006;69(9):1641-8. doi: 10.1038/sj.ki.5000289. [PubMed: 16572119].
  12. Kiyoshi Y, Oh Y, Uesugi N, Ikeda K, Yanase T, Fujimi S. Glomerular score as a prognosticator in IgA nephropathy: its usefulness and limitation.%A Katafuchi R. Clinical nephrology. 1998;49(1):1-8.
  13. Simon P, Ramee MP, Boulahrouz R, Stanescu C, Charasse C, Ang KS, et al. Epidemiologic data of primary glomerular diseases in western France. Kidney International. 2004;66(3):905-8.
  14. Polito MG, de Moura LAR, Kirsztajn GM. An overview on frequency of renal biopsy diagnosis in Brazil: clinical and pathological patterns based on 9,617 native kidney biopsies. Nephrol Dial Transplant. 2010;25(2):490-6. doi: 10.1093/ndt/gfp355. [PubMed: 19633091].
  15. Kazi JI, Mubarak M, Ahmed E, Akhter F, Naqvi SA, Rizvi SA, et al. Spectrum of glomerulonephritides in adults with nephrotic syndrome in Pakistan. Clin Exp Nephrol. 2009;13(1):38-43. doi: 10.1007/s10157-008-0075-0. [PubMed: 18685922].
  16. Rychlík I, Jančová E, Tesař V, Kolský A, Lácha J, Stejskal J, et al. The Czech registry of renal biopsies. Occurrence of renal diseases in the years 1994-2000. Nephrology Dialysis Transplantation. 2004;19(12):3040-9.
  17. Das U, Dakshinamurty KV. Pattern of biopsy-proven renal disease in a single center of south India: 19 years experience. Indian J Nephrol. 2011;21(4):250-7.
  18. Stubbs JR, House JA, Ocque AJ, Zhang S, Johnson C, Kimber C, et al. Serum Trimethylamine-N-Oxide is Elevated in CKD and Correlates with Coronary Atherosclerosis Burden. J Am Soc Nephrol. 2016;27(1):305-13. doi: 10.1681/ASN.2014111063. [PubMed: 26229137]. [PubMed Central: PMC4696571].
  19. Zhang XD, Cui Z, Zhao MH. The Genetic and Environmental Factors of Primary Membranous Nephropathy: An Overview from China. Kidney Dis (Basel). 2018;4(2):65-73. doi: 10.1159/000487136. [PubMed: 29998121]. [PubMed Central: PMC6029227].
  20. Li SJ, Zhang SH, Chen HP, Zeng CH, Zheng CX, Li LS, et al. Mercury-induced membranous nephropathy: clinical and pathological features. Clin J Am Soc Nephrol. 2010;5(3):439-44.
  21. Hofstra JM, Wetzels JF. Alkylating agents in membranous nephropathy: efficacy proven beyond doubt. Nephrol Dial Transplant. 2010;25(6):1760-6. doi: 10.1093/ndt/gfq017. [PubMed: 20133280].
  22. Horvatic I, Ljubanovic DG, Bulimbasic S, Knotek M, Prkacin I, Tisljar M, et al. Prognostic significance of glomerular and tubulointerstitial morphometry in idiopathic membranous nephropathy. Pathol Res Pract. 2012;208(11):662-7. doi: 10.1016/j.prp.2012.08.004. [PubMed: 22995635].
  23. Chen Y, Tang L, Feng Z, Cao X, Sun X, Liu M, et al. Pathological predictors of renal outcomes in nephrotic idiopathic membranous nephropathy with decreased renal function. J Nephrol. 2014;27(3):307-16.
  24. Li LS, Liu ZH. Epidemiologic data of renal diseases from a single unit in China: analysis based on 13,519 renal biopsies. Kidney Int. 2004;66(3):920-3.
  25. Naini AE, Harandi AA, Ossareh S, Ghods A, Bastani B. Prevalence and clinical findings of biopsy-proven glomerulonephritidis in Iran. Saudi J Kidney Dis Transpl. 2007;18(4):556-64.