Clinical And Pathological Characteristics Of IgA Nephropathy And Analysis Of Risk Factors Associated With The Renal Pathologic Lesions

Objective : IgA nephropathy(IgAN) is the most common form of primary glomerulonephritis worldwide,the clinical and pathological manifestations are diverse,but also the developing disease.The purpose of this study is to study the clinical and pathological characteristics of IgA nephropathy patients and analysis the risk factors associated with the renal pathologic lesionsMethod : 51patients with IgA nephropathy were collected from the inpatients who were diagnosed as IgA nephropathy by renal biopsy.Includeing 21 cases of male,female 30 cases,the average age of 33.03±10.1 years old.Except for purpuric nephritis,lupus nephritis,glomerular sclerosis,and HBV asociated nephropathy and other secondary kidney disease.And the clinical index of different severity of renal pathologic lesions was compared;the relationship between renal pathologic lesions and clinical features were studied.According to the severity of renal pathologic lesions are divided into A group(including Lee's grade I,Ⅱlevel,n=29),B group(including Lee's gradeⅢ,Ⅳ,V-level,n=22).Lee's classification standards by the literature [ 1 ] .All patients were carried out immunofluorescent IgG,IgA,IgM,C3,C4,C1q staining.Analysis of its clinical and pathological characteristics,according to the severity of renal pathologic lesions,the predicted factors were analyzed by step—wise multiple variance regrcssion an analysis.Results:1.Comparison of the clinical features:A group of 29 cases,7 cases of male,female 22 cases,the average age of 33.0±10.15,an average duration was 5 months;B group 22 cases,14 cases of male,female 8 cases,the average age of 32.0±9.17,The average duration was also 5 months.Between the two groups, there is no significant difference(P=0.703,0.573)in age and duration.In A,B groups the incidence of male repectively accounted for 24.13%,64.64%; hypertension accounted for 31.0%,40.9%;renal failure accounted for 3.4%,36.4%;nephritis syndrome accounted for 27.6%,27.3%;the incidence of ne- phrotic syndrome in A,B two groups repectively were 13.8%,9.1%;the incidence of microscopic hematuria repectively were 17.2%,0%;the incidence of asymptomatic proteinuria accounted for 31.0%,27.3%;the incidence of male,renal failure in group A was significantly lower than B group(x2 values were 8.058,9.326,P value<0.05);the incidence of hematuria in group A was significantly higher than B group(x2 value were 4.176,P<0.05).Between the two groups the incidance of mean arterial blood pressure,hypertension,microscopic hematuria,nephrotic syndrome,nephritis syndrome,and asymptomatic protein- uria were no significant difference(P>0.05).2.In A group the level of serum creatinine,serum uricacid,24h Urinary protein excretion,was significantly lower than B group(P<0.05).Between the two groups the level in blood lipids,hemoglobin,serum albumin had no significant difference(P>0.05).3.The degree of renal pathologic lesions in patients with IgA nephropathy, A group of 29 cases(56.87%),showed mild renal pathologic lesions,including Lee's16 cases of grade I-grade(31.4%),Ⅱgrade 13 cases (25.5%);B group 22 cases(43.13%),showed moderate to severe renal pathologic lesions,including Lee's8 cases of gradeⅢ(15.7%),12 cases (23.5%)of gradeⅣ,2 cases (6.0%) of grade V.4.Multi-factor risk analysis showed that serum creatinine,24h urinary protein excretion were independent predictors of the severity of renal path- ologic lesion in lgA nephropathy patients(0R values repectively were 1.033, 1.001;P value of 0.038,0.021).With the increasing of serum creatinine, 24h urinary protein excretion the renal pathologic lesion are more serious.Conclusion:Based on terms of age and duration in no significant difference in IgA nephro-pathy,the incidence of male is higher More than half of pathological lesions in patients with IgA nephropathy are mild, similar to minimal change nephropathy or mild mesangial proliferative glomerulonephritis, while the other parts of renal pathologic lesions are severe. Hematuria in patients with IgA nephropathy may be a better prognosis,but microscopic hematuria may be associated with renal pathologic lesions little The high level in Urinary protein excretion,serum creatinine are the risk factors for renal pathologic lesions in IgA nephropathy High blood pressure to renal pathologic lesions in IgA nephropathy may have little.