Prognostic factors of idiopathic membranous nephropathy treated with angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker

Sun Binbin; Zhang Beiru; Bian Xiaohui; Zhao Zixia; Yu Rui; Zhang Yongzhe; Wang Yanqiu

doi:10.3760/j.issn.1673-4777.2019.01.020

Abstract：Objective To investigate the prognosis and related factors of idiopathic membranous nephropathy (IMN) treated with angiotensin converting enzyme inhibitor/angiotensin Ⅱ receptor blocker (ACEI/ARB).Methods From December 2011 to December 2016,85 IMN patients diagnosed by renal biopsy in Shengjing Hospital of China Medical University were enrolled.All patients were treated with ACEL/ARB alone.According to the therapeutic response,they were divided into remission group and no remission group;the no remission group was treated with glucocorticoids and/or immunosuppressants subsequently.Basic information,biochemical indexes and pathological results were compared between groups.Prognostic factors of IMN patients treated by ACEI/ARB were analyzed.Results There were 46 patients in the remission group(29 complete remission,17 partial remission) and 39 patients in the no remission group.Proportion of patients under 60 years old and estimated glomerular filtration rate in the remission group were higher than those in the no remission group[89.1％ (41/46) vs 66.7％ (26/39),(138 ±29)ml/(min · 1.73 m2) vs (120 ±28)ml/(min · 1.73 m2)].Proportion of patients with diabetes and level of serum cystatin C in the no remission group were higher than those in the remission group [20.5％ (8/39) vs 2.2％ (1/46),(1.04 ± 0.32) mg/L vs (0.91 ± 0.17) mg/L].The no remission group had higher interstitial inflammatory cell infiltration score and lower complement C3 sedimentation degree (all P ＜ 0.05).Logistic multivariate regression analysis showed that diabetes history and high serum cystatin C level were independent risk factors of the prognosis of IMN (dds ratio =408.862,46.973;95％ confidence interval:4.447-37 590.022,3.091-713.836;P ＜ 0.01).Conclusions Monotherapy with ACEI/ARB can relieve IMN in some patients.Diabetes history and high serum cystatin C level may have adverse affect the therapeutic response of IMN.