Clinical And Pathological Significance Of Intrarenal Arteriolar Lesions In The Patients With IgA Nephropathy With Or Without Hypertension

Objective: To develop quantitative criteria for evaluating intrarenal arteriolarlesions，and to know the extent and affect of such arteriolar lesions in the patientswith IgA nephropathy with or without hypertension.Method: We analyzed data on consecutive50non-IgA nephropathy patients withnormal small arteries from March,2010to October,2013at division of nephrology inBeijing Anzhen Hospital. All of patient’s arteriolar inside diameters and outsidediameters were measured by indirect method. Then calculate average value ofarteries’ inside diameters/outside diameters and use the average to evaluate thedegrees of severity of arteriolar lesions. The criteria for evaluating intrarenalarteriolar lesions were developed, base on the data. According to the criteria, weseparated305patients with IgA nephropathy into3different groups (normal, mildand severe) and compared the clinical and pathological characteristics such as age,sex, systolic blood pressure, diastolic blood pressure, serum creatinine, urine protein,urine osmotic pressure and proportion of ischemic glomerulosclerosis between them.Use the same procedure to analyze147IgA nephropathy patients with normal bloodpressure.Results: The average of all of the non-IgA nephropathy patients’arteriolar inside diameters/outside diameters was0.52±0.05. The criteria of arteriolarlesions were defined as follows: the ratio of luminal diameter to outer diameter＞0.48was normal;0.45-0.48was mild;≤0.45was severe. Among305patients with IgAnephropathy the prevalence of arteriolar lesions was36.4%and13.3%of thosepatients with severe lesions. The cases of intrarenal arteriolar lesions had significantlyhigher systolic blood pressure, diastolic blood pressure, serum creatinine level,proportion of ischemic glomerulosclerosis and lower urine osmotic pressurecompared with normal cases (P＜0.05). The severe lesion group had higher diastolic blood pressure, serum creatinine and proportion of ischemic glomerulosclerosis,compare with mild lesion group(P＜0.05). Through variables selected for the logisticregression model we found that systolic blood pressure, serum creatinine, urineosmotic pressure and proportion of ischemic glomerulosclerosis associated witharteriolar lesions independently. Among the147IgA nephropathy patients withnormal blood pressure,26.5%of them with arteriolar lesions and7.5%with severelesions. Compare with normal group, the cases of intrarenal arteriolar lesions hadsignificantly higher serum creatinine level and proportion of ischemicglomerulosclerosis compared with normal cases (P＜0.05). The significantly lowerurine osmotic pressure only appeared in the cases of severe arteriolar lesions (P＜0.05). Among the IgA nephropathy patients with normal blood pressure, urineosmotic pressure and proportion of ischemic glomerulosclerosis associated witharteriolar lesions independently.Conclusion: We developed intrarenal arterial lesions evaluation criterion forpatients with IgA nephropathy. Intrarenal arterial lesions appeared in IgA nephropathypatients with or without hypertension, and the arteriolar lesions are frequentlyassociated with more severe glomerular and tubular dysfunction.