성인 막성신병증의 임상적 고찰 = A Clinical and Pathological Study of Adult Membranous Nephropathy

다국어 초록 (Multilingual Abstract)

Membranous nephropathy (MN) is a glomerular disease characterized by diffuse thickening of the glomerular basement membrane without significant mesangial proliferative change and is usually manifested by the nephrotic syndrome.
To evaluate the clinical and pathologic characteristics of this disease in adults, we analyzed 65 patients with primary membranous nephropathy who were diagnosed at Department of Internal Medicine, Chungnam National University Hospital from February 1986 to February 2001.
The results are as follows:
1) Of total 96 patients with membranous nephropathy, 67.7% was primary MN. Hepatitis B-associated MN and lupus MN were 22.9%, and 9.4%, respectively. Median duration of follow-up was 35.1 months(0.3∼177) in primary MN, 49.6 months(2.5∼103) in lupus MN, and 35.6 months(0.5∼108) in hepatitis B-associated MN.
2) Mean age of the patients with primary MN at the time of diagnosis(43.3 years) was significantly higher than that of lupus MN(30.4 years) and HBV-associated MN(36.2 years). Male to female ratio of primary MN was 1.03:l.
3) At the time of diagnosis, 89.2% of primary MN was presented with nephrotic syndrome. Twenty seven percent of patients showed hypertension. Hematuria was found in 58.5% of primary MN patients. Azotemia was noted in 3.1 %.
4) Global sclerosis, tubular atrophy and interstitial fibrosis were noted in 39.8, 16.1 and 11.3% of primaty MN, respectively. IgG and C3 were deposited on the glomerular capillary loop in 92.7% and 29% of primary MN patients. There was no significant correlation between the electron microscopic pathologic stage and clinical findings.
5) Of 56 patients with primary MN followed more than 6 months, 50(90.9%) patients were treated with prednisolone, cyclophosphamide or cyclosporin. Complete remission was obtained in 29 patients(51.8%), partial remission in 6 patients(10.7%), and no response in 18 patients(32.1%). Of 6 patients who were not treated with immunosuppressive drugs, 3 patients showed spontaneous complete or partial remission. Three patients who did not show clinical improvement progressed to end-stage renal failure. There were no significant clinical difference including renal pathology at the time of diagnosis between the patients who showed complete or partial remission and patients who did not.
In conclusion, it was difficult to predict the long-term prognosis of primary MN at the time of diagnosis, clinically. The response to therapeutic modality would be the most important to predict long-term prognosis of primary MN.