The pathology and long-term prognosis of 16 cases of children's idiopathic membranous nephropathy

Objective To explore the pathology and prognosis of children with idiopathic membranous nephropathy(IMN).Methods Clinical manifestations,pathology,treatment and prognosis of 16 children with IMN were reviewed to explore the prognosis of children's idiopathic membranous nephropathy.Results From 1979 to July 2010,consecutive 16 patients diagnosed as IMN were analyzed,accounting for 0.94% of all renal biopsy patients,with the ratio of male:female:10:6,the median age:(5.2±2.6) years.Eleven patients were with nephritic syndrome(68.8%),5 with asymptomatic proteinuria(31.2%),2 children with hypertension(12.5%),2 children with renal insufficiency(12.5%).Fourteen of 16 patients received phathological examination under electronic microscopy,showing that 6 were graded as stage Ⅰ(42.9%),6 as stage Ⅰ-Ⅱ(42.9%),1 as stage Ⅱ(7.1%),1 as stage Ⅱ-Ⅲ(7.1%).No tubular atrophy or interstitial fibrosis were observed.For the patients having proteinuria50 mg·kg-1,no steroids or immunosuppressants were provided for treatment.The patients having proteinuria50 mg·kg-1 were given steroids(2 mg·kg-1·d-1).Immunosuppressants were given to non-responders or reliers to steroids.After(34.0±18.7) months,14 patients were all remitted,and had normal renal function.Conclusions IMN mainly presents as nephritic syndrome.Better prognosis can be expected among patients with younger age,lower pathologic grade,and not combined with interstitial fibrosis.Diagnosis and treatment early can improve the prognosis of children's idiopathic membranous nephropathy.