157 Cases Of IgA Nephropathy: Study Of Clinicopathological Features And Prognosis

Objective:To investigate the four pathology variables recommended by IgA nephropathy Oxford classification and its relationship with prognosis of IgAN.Methods:Clinical and pathological data of 157 patients(80 males and 77females)with primary IgA nephropathy confirmed by renal biopsy in Gui Zhou Provincial People's Hospital from June 2005 to June 2010 were reviewed retrospectively and were correlated with outcomes. Patients were followed for at least 12 months.157 cases IgAN patients were divided into two large groups according to the four pathological variables recommended by the IgAN Oxford classification(①the mesangial hypercellularity score,②segmental glomerulosclerosis,③endocapillary hypercellularity, and④tubular atrophy/interstitial fibrosis),one is the Combinations of glomerular features group, included M0-S0-E0,M0-S1-E0,M1-S0-E0,M1-S0-E0,M0/1-S0-E1,M0/1-S1-E1;the other is the combinations of glomerular and tubulointerstitial features group.included M0-EO-TO,MO-E0-T1-2,M1-E0-T0,M1-E0-T1-2,M0/1-E1-T0,M0/1-E1-T1-2. All patients received medical examination every six months, included:①mean arterial pressure,②proteinuria(24 urine protein quantitative),③blood(serum) urea nitrogen,④serum creatinine,⑤serum cystain C.Results:the mesangial hypercellularity scores were higher than others in these three of clinical classifications:MP, ESRF and Cres. The segmental glomerulosclerosis scores were higher than others in these three of clinical classifications:HT, ESRF and Cres. the tubular atrophy/interstitial fibrosis scores were higher than others in these two of clinical classifications:ESRF and Cres. (table 1) There were higher blood urea nitrogen(BUN) and serum creatinine(SCr) significantly in patients with MO-S1-EO,M1-S1-E0,M0/1-S1-E1, than that in patients with others combinations of glomerular features groups. (table 2 and figure 8 to 12). There were higher blood urea nitrogen(BUN),serum creatinine(SCr) and cystain C significantly in patients with M0-E0-T1-2,M1-E0-T1-2,M0/1-E1-T1-2 than that in patients with others combinations of glomerular and tubulointerstitial features groups. (table 3 and figure 17 to 21).Conclusions:Four of these pathology variables recommended by IgA nephropathy Oxford classification are independently predictive of clinical outcome:(1) the mesangial hypercellularity score, (2) segmental glomerulosclerosis, (3) endocapillary hypercellularity, and (4) tubular atrophy/interstitial fibrosis. Intra-flow tip good prognosis, others tip poor prognosis.