Chronic Duration Of IgA Nephropathy TCM Syndrome And Correlation Analysis Of Clinical Pathology

BackgroundIgA nephropathy is an immunopathological diagnosed disease. It is characterized by the deposition of IgA immune complexes in the glomerular mesangial, often accompanied by deposition of complement C3. IgA nephropathy is the most common primary glomerular disease around the world, is also one of the major causes of end stage renal desease (ESRD).Because the pathogenesis of IgA nephropathy isn’t clear yet, there is still a lack of a unified and effective treatment for IgA nephropathy. In order to better guide clinical diagnosis and treatment, in2013, China Society of Integrated Traditional Chinese and Western Medicine for Kidney Disease published a guideline of the diagnosis and TCM syndrome differentiation for IgA nephropathy, which divided IgA nephropathy into two stages, the acute exacerbation and chronic duration stage. Chinese medicine has a certain effect in improving chronic stage patients’immunity, prevent evils, reducerecidivation, remission hematuria, proteinuria and other symptoms.At the same time, the study of clinical and histological risk factors for IgA nephropathy has been a hot spot, a large number of studies have shown that clinical indicators such as24h urine protein>lg, serum creatinine, blood pressure and pathological injury such as glomerulosclerosis, tubular fibrosis are independent risk factors of IgA nephropathy. Hyperuricemia, the deposition of complement C3in the glomerular mesangial also gradually be taken seriously on the long-term prognosis of IgA nephropathy.This study is intended to analyse the chronic duration IgA nephropathy patients’TCM syndrome and find the correlation between TCM syndrome, clinical indicators and renal pathology, in order to better guide clinical treatment and prognosis evaluation.ObjectiveStudy the distribution of chronic duration IgA nephropathy patients’TCM syndrome and find the correlation between TCM syndrome, clinical indicators and renal pathology, in order to better guide clinical treatment and prognosis evaluation.MethodsRetrospective analyze62cases of chronic duration IgA nephropathy patients which was diagnosed by nephrology renal biopsy in Guang An Men Hospital, China Academy of Traditional Chinese Medicine from January2012to December2013. TCM syndrome differentiation references the guidline which was published in2013by China Society of Integrated Traditional Chinese and Western Medicine for Nephropathy. Preliminary study the the correlation between TCM syndrome, clinical indicators and renal pathology of chronic duration IgA nephropathy.Resultsl.The general informationBetween January2012and December2013in Guang An Men Hospital, China Academy of Traditional Chinese Medicine, the total number of chronic stage IgA nephropathy is62cases, accounted for72.94%of all primary IgA nephropathy patients during this period. The male to female ratio is1.296:1, the average age was37.87±1.33years old, the age mainly distributed in30-39years old, accounts for33.87%of the total. The most common complication is hypertension,44cases (70.97%).2. TCM syndrome researchThe most common syndrome is Qi and Yin Deficiency syndrome in20cases (32.26%), followed by Lung and Spleen Deficiency syndrome in17cases (27.42%), Liver and Kidney Yin Deficiency syndrome in13cases(20.97%), Spleen and Kidney Yang Deficiency syndrome in12cases (19.35%).The most common concurrent syndrome is blood stasis syndrome in16cases (25.81%), followed by Damp-Heat syndrome in10cases (16.13%), Damp syndrome in9cases (14.52%), Cold-dampness syndrome in4cases (6.45%), Liver Stagnation syndrome in4cases (6.45%), Phlegm-dampness syndrome in3patients (4.84%), Turbidity-toxin syndrome in3patients (4.84%).3. The relevance between TCM syndrome and clinical indicators3.1The relationship between TCM syndrome and24h Urine Protein24h urine protein between the four groups of TCM syndrome has statistical differences (P=0.005).24h urine protein of Spleen and Kidney Yang Deficiency syndrome is higher than that of Qi and Yin Deficiency syndrome and Lung and Spleen Deficiency syndrome (P=0.018, P=0.018);24h urine protein in Liver and Kidney Yin Deficiency syndrome is higher than it in Lung and Spleen Deficiency syndrome(P=0.038).3.2The relationship between TCM syndrome and Serum Creatinine10cases (16.13%) has increased serum creatinine, including Lung and Spleen Deficiency syndrome1case (5.88%), Qi and Yin Deficiency syndrome3cases (15%), Liver and Kidney Yin Deficiency syndrome2cases (15.4%), Spleen and Kidney Yang Deficiency syndrome4cases (33.3%). The incidence of elevated serum creatinine in Spleen and Kidney Yang Deficiency syndrome is higher than the Lung and Spleen Deficiency syndrome, there are statistically significant differences (P=0.005). 3.3The relationship between TCM syndrome and HypertensionThe incidence of hypertension between different syndromes has no statistical difference (P>0.05).3.4The relationship between TCM syndrome and HyperuricemiaThe incidence of hyperuricemia between different syndromes has no statistical difference (P>0.05).3.5The relationship between TCM syndrome and CKD stageThe chronic kidney disease (CKD) stage between different TCM syndrome has statistically significant differences (P=0.006).3.6The relationship between TCM syndrome and Serum AlbuminSerum albumin between the four groups of TCM syndrome has statistical differences (P=0.046). Serum albumin of Spleen and Kidney Yang Deficiency syndrome is lower than that of Lung and Spleen Deficiency syndrome and Liver and Kidney Yin Deficiency syndrome (P=0.012, P=0.015).3.7The relationship between TCM syndrome and other clinical indicatorsOther clinical indicators, such as hemoglobin, blood uric acid, blood urea nitrogen, total cholesterol, triglyceride and low density lipoprotein cholesterol, compare between the four groups of TCM syndrome, has no statistical difference (P>0.05).4. The relevance between TCM syndrome and Renal Pathology4.1The relationship between TCM syndrome and Renal Pathologic ScoreThe62cases chronic duration IgA nephropathy patients’ renal pathology was scored by Katafuchi semi-quantitative score method, glomerular score between the four groups of TCM syndrome, has statistical differences (P=0.044). Glomerular score of Lung and Spleen Deficiency syndrome is lower than that of Qi and Yin Deficiency syndrome and Spleen and Kidney Yang Deficiency syndrome (P=0.011, P=0.038).4.2The relationship between TCM syndrome and C3depositionThe strength of C3deposition compare between four syndromes, has no statistical difference (P>0.05).5. The relevance between Clinical Indicators and Renal Pathology5.1The relationship between24h Urine Protein and Renal Pathologic ScoreThe score of glomerular, tubulointerstitial, blood vessels and pathology total score in24h urine protein>lg group is higher than24h urine protein<1g group (P<O.05or P<0.01).5.2The relationship between Serum Creatinine and Renal Pathologic Score The score of glomerular, tubulointerstitial, blood vessels and pathology total score in elevated serum creatinine group is higher than normal serum creatinine group (P<0.05or P<0.01).5.3The relationship between Hypertension and Renal Pathologic ScoreThe score of blood vessels in hypertension group is higher than normal blood pressure group, there is statistical difference (P<0.05). The score of glomerular, tubulointerstitial and pathology total score have no statistical differences between the two groups(P>0.05).5.4The relationship between Hyperuricemia and Renal Pathologic ScoreThe score of tubulointerstitial and pathology total score in hyperuricemia group are higher than normal uric acid group (P<0.05). The score of glomerular and blood vessels have no statistical differences between the two groups(P>0.05).5.5Correlation analysisSerum creatinine, blood uric acid, blood urea nitrogen has a positive correlation with all the renal pathologic score.24h urine protein has a positive correlation with the score of tubulointerstitial, blood vessels and pathology total score (P<0.05or.P<0.01).Conclusions1. The TCM syndrome of chronic duration IgA nephropathy patients have certain correlation with clinical and pathological factors. The clinical and pathological manifestations in Lung and Spleen Deficiency syndrome is lighter, in Spleen and Kidney Yang Deficiency syndrome is heavier.2. Chronic duration IgA nephropathy patients’clinical factors such as24h urine protein>lg, elevated serum creatinine, hypertension, hyperuricemia have certain relevance with renal pathology.