Clinical and pathological features of idiopathic membranous nephropathy with focal segmental lesion

Objective To investigate the clinical-pathological features and prognosis of idiopathic membranous nephropathy (IMN) with focal segmental lesion. Methods Two hundred and ninety-eight patients with biopsy-proven IMN in our hospital were retrospectively analyzed. The patients were divided into three groups: without focal segmental lesion group (FSL-), with focal segmental glomerulosclerosis group (FSGS) and with early focal segmental lesion group (EFSL). The differences of clinical and pathological features and prognosis in the 3 groups were studied. Results There were later pathological stage, higher ratio of chronic renal tubulointerstitial damage and global glomerular sclerosis in FSGS group than those in the other two groups (all P＜0.05). The male ratio in EFSL group was higher than that inFSL- group (P＜0.01), while the level of serum albumin was lower (P＜0.05). Compared withFSL- group, there was longer average course before renal biopsy, higher blood pressure and levels of Scr in FSGS group (all P＜0.05)．Furthermore, the remission rate in EFSL group was lower than that in FSGS group andFSL- group. Survival analysis showed that FSGS group had worse prognosis (FSGS toFSL-, P=0.005, FSGS to EFSL, P=0.008). The analysis of risk factors suggested that triacylglycerol (OR=1.519, P=0.017), glomerulosclerosis (OR=1.073, P=0.041) and FSGS lesion (OR=5.960, P=0.009) were independent risk factors for renal death. Conclusions There were some differences between EFSL and FSGS lesion, both in clinical manifestations and pathology. FSGS lesion was independent predictive factor for progression to renal death. And the lowest remission rate was in EFSL group.