Clinicopathological analysis of idiopathic membranous nephropathy in young adults

Abstract

ABSTRACT. The aim of this study was to understand the clinicopathological features and prognosis of idiopathic membranous nephropathy (IMN) in youth. A retrospective analysis of the clinicopathological features and prognoses of pathologically confirmed IMN in 21 patients aged 15-30 years was performed. IMN was mainly characterized as nephrotic syndrome (NS), with stage I as the main pathological stage, and associated with hyperplasia of the glomerular mesangial cells and ground substance. High-intensity immunofluorescence also showed multi-site deposition of a variety of immune complexes, and electron microscopy showed multi-site deposition of electron-condensing substances. In the present study, 4 patients received non-specific treatment. Among 17 NS patients, 12 patients exhibited a preference for glucocorticoid therapy, and of these patients, 7 were sensitive to therapy and 5 were resistant. In the 12 patients who received hormone treatment combined with immunosuppressants (including 5 patients who were treated with the combination from the initial start, 5 patients who were steroid resistant, and 2 patients who were sensitive to the initial hormone treatment but who later showed relapse), complete remission was achieved in 6 patients, partial remission was achieved in 2, the treatment was Y. Wang et al. 4542©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (2): 4541-4548 (2015) ineffective in 2, and 2 patients were lost to follow-up. In conclusion, the clinical manifestation of IMN in youth in this study was mainly NS. In most patients, the initial hormone treatment was effective, and in some patients, the combination of hormone and immunosuppressant treatment was effective. As the sample size in this study was small, further clinical validation is still required to determine the efficacy of the treatment.

Membranous nephropathy: not just a disease for adults

“…In pediatric cases of MN, however, hematuria is more common and has been reported in up to 69% of patients [14]. Among those of Asian ancestry, the prevalence of hematuria has been reported to be as high as 92% and 100% in cohorts of MN cases from Japan and China, and gross hematuria was found in 30% and 28%, respectively [20,21]. …”

“…Although reported rates in children are variable, hypertension appears to be less common in the pediatric MN population [7,14,21]. Thromboembolism is a significant life-threatening complication of nephrotic syndrome and thromboembolic events are more common in MN than in other causes of the nephrotic syndrome.…”

The clinicopathological features of patients with membranous nephropathy

“…10 In previous studies, some typical clinical manifestations have been identified in patients with MN, such as NS, edema, hypertension, renal failure, and microscopic hematuria. 11 According to the guidelines of pathology, MN cases can be divided into four pathological stages (stages I, II, III, and IV). 12,13 Renal dysfunction can usually be detected in patients who have had MN for 5-10 years and pathological stage III or IV.…”

Different Effects of Tolvaptan in Patients with Idiopathic Membranous Nephropathy with Nephrotic Syndrome

“…IMN occurs typically in middle-aged adults, with the main clinical manifestation being the nephrotic syndrome (10). Treatment of IMN using immunosuppressants is controversial, because there are two conflicting possibilities: 1) progression to renal failure and end-stage renal disease, 2) spontaneous remission, which is more common than expected (12,13).…”

“…On the 5th day, renal biopsy was performed. Histopathology showed typical stage II MN including diffuse thickening of the basement membrane and a large number of electron-condensing substances on the subepithelium (10). An immunofluorescence examination showed granular IgG and C3 deposition on the capillary loops.…”