To analyze the characteristics of intrarenal arterial lesions (AL) and their effect on prognosis of idiopathic membranous nephropathy (IMN) patients without hypertension and diabetes.

A retrospective analysis was performed on the data of patients, who had renal-biopsy-diagnosed IMN without hypertension and diabetes, in the Department of Nephrology, Chinese PLA General Hospital from January 1, 2011 to April 30, 2018, including basic information, laboratory examination, renal pathology, and treatment plan, while renal pathology scoring was also conducted. Kaplan-Meier survival curve method was used to analyze the impact of AL on prognosis of the IMN patients. Logistic regression and Cox regression models were applied to analyze the risk factors for prognosis of the IMN patients.

A total of 1293 IMN patients were included, among whom 660 patients with AL were taken as the AL (+ ) group, while 633 patients without AL lesions as the AL (-) group. Compared with the AL (-) group, the AL (+ ) group had higher levels in age, systolic blood pressure, diastolic blood pressure, and serum creatinine (all P<0.05), with significant increases in global glomerulosclerosis and interstitial lesions (both P<0.001). A total of 404 patients completed a median follow-up of 8.0 (4.0-18.0) months, including 172 cases in the AL (+ ) group and 232 cases in the AL (-) group. At 9, 12, and 24 months after renal biopsy, the complete response rate of drugs treatment in the AL (-) group was higher than that of the AL (+ ) group (P<0.05). Adverse events of drugs treatment occurred in 126 patients, which were significantly fewer in the AL (-) group than in the AL (+ ) group (P=0.004). The eGFR decreased by more than 25% in 15 patients, among whom there were fewer patients from the AL (-) group than from the AL(+ ) group (P=0.003). Three patients progressed to ESRD, with all of whom in the AL (+ ) group (χ²=4.067, P=0.044). Multivariate Cox regression analysis showed that the high baseline serum creatinine level (HR= 1.032, 95%CI: 0.009-1.056, P=0.006) and AL (HR=8.786, 95%CI: 1.167-66.144, P=0.035) were independent risk factors for renal function deterioration.

IMN patients with intrarenal AL had more severe clinical and pathological manifestations, more adverse events, and poorer renal prognosis. Intrarenal AL was an independent risk factor for the prognosis of the IMN patients.