关键词: 汞, 肾病综合征, 肾脏病理, 预后

Abstract: Ｏｂｊｅｃｔｉｖｅ：To investigate the clinicopathological features,treatment and prognosis of glomerulonephropathy caused by mercuryincluding cosmetics.
Ｍｅｔｈｏｄｏｌｏｇｙ：A retrospective analysis of patients diagnosed as mercuryinduced glomerulonephropathy by medical history,clinical,renal biopsy and urine mercury detection due to skin lighting cream from January 2013 to December 2019 in Jinling Hospital was performed.Clinical manifestations,laboratory test,renal pathological characteristics,treatment and prognosis were analyzed.
Ｒｅｓｕｌｔｓ：A total of 41 cases were collected.They were all females,with an average age of （394±66） years at diagnosis.The median time of exposure to skin lighting cream was 6 months,and the average urine mercury level was 6680 ± 3855 μg/（g·Cr）.Most patients (32/41) were presented with nephrotic syndrome (NS).Renal histopathology showed membranous nephropathy (MN) in 22 patients(5365%),minimal change disease (MCD) in 13 patients (3171%),IgANMCD in 5 patients (1220%) and focal segmental glomerulosclerosis (FSGS) in 1 patient (244%).Median time of exposure to mercury was longer and proportion of patients with autoantibodies (mainly ANA) was higher in patients with MN.Both of  blood phospholipase A2 receptor (PLA2R)Ab and kidney tissue PLA2R were negative.Thirtysix patients received glucocorticoid and/or immunosuppressant，5 patients were treated with angiotensin receptor blocker (ARB).Nine patients were combined with mercury detoxification.Thirtytwo patients (7805%) achieved complete remission (CR) in 10 (range 05～110) months,8 patients (1951%) achieved partial remission (PR).One patient relapsed during glucocorticoid withdraw,and 15 patients discontinued the drugs successfully.
Ｃｏｎｃｌｕｓｉｏｎ：MN was the most common pathological type in mercuryinduced glomerulonephropathy,followed by MCD and IgANMCD.Most patients could achieve remission after immunosuppressive therapy.

Key words: mercury, nephrotic syndrome, renal pathology, prognosis