Clinical And Pathological Analysis Of IgA Nephropathy Presenting With Nephrotic Syndrome

Objectives:To analysis the relationship between the clinical and pathological characteristics of Ig A nephropathy patients with nephrotic syndrome and with non-nephrotic syndrome.To further study the clinical and pathological characteristics of Ig A nephropathy patients with nephrotic syndrome,in order to provide the basis for clinical diagnosis and prognosis.Methods:A retrospective analysis of 216 cases with Ig A nephropathy diagnosed by renal biopsy in Nephrology Department of the First Hospital of Jilin University from October 2010 to November 2015.All objects conform to the inclusion and exclusion criteria,and has a complete general clinical and laboratory parameters.According to the clinical manifestation,the patients were divided into groups of nephrotic syndrome(NS group,n=62)and non-nephrotic syndrome(non-NS group,n=154).We analyzed the clinical and pathological relationship between the two groups.The 62 cases of Ig A nephropathy patients with nephrotic sydndrome were further divided into mild to moderate group(n=32,including Lee’s classification grades Ⅰ, Ⅱ and Ⅲ) and severe group(n=30,including Lee’s classification grades Ⅳ and Ⅴ)according to the severity of renal pathological grades,we compared the two groups in general and clinical parameters.The renal pathological lesion was graded according to Lee’s classification standard. SPSS18.0software was adopted for statistical analysis.Results:1、There are 1601 cases of patients receiving renal biopsy during October 2010 to November 2015 in our hospital,including 346 cases of primary Ig A nephropathy,accounting for 21.61% of the total number of the patients who receive renal biopsy.2 、 Ig A nephropathy is more common in youth among the 216 patients with Ig A nephropathy conforming to the inclusion and exclusion criteria.The ratio of male/female is 1.25:1,the peak onset age is 20 to 40 years old.Among the 216 Ig A nephropathy patients,presentation of hematuria and proteinuria is the most common clinical manifestation,accounting for 81.94%,followed by hypertension and edema,50% and 41.67% respectively.There are 62 cases of patients presenting with nephrotic syndrome,accounting for 28.70%.The most common pathological classification is grade Ⅲ, accounting for 44.91%.3、Among the Ig A nephropathy patients, nephrotic syndrome group has shorter course of disease than non-nephrotic group and has a higher edema incidence(p < 0.01);The nephrotic syndrome group has higher levels of serum creatinie and blood urea nitrogen(p < 0.05,0.01respectively),and the glomerular filtration rate is much lower(p <0.01),suggesting a worse renal function; The nephrotic syndrome group has higher levels of cholesterol,low density lipoprotein cholesterol and high density lipoprotein cholesterol(p<0.01,0.01,0.05 respectively) and has a lower level of hemoglobin(p<0.01);GradesⅡ and Ⅳ are more common in the nephrotic syndrome group,grade Ⅲ is more common in the non-nephrotic syndrome group.There is significant difference between the two groups of pathological grade distribution.4 、 Grades Ⅱ 、 Ⅲ and Ⅳ are more common among the Ig A nephropathy patients with nephrotic syndrome.The group with severe pathological lesion has higher incidences of hematuria,renal insufficiency and hypertension compared with the group with mild to moderate pathological lesion(p<0.05,0.01,0.01 respectively).The severe group has higher levels of serum cretinine and blood urea nitrogen,has lower levels of the glomerular filtration rate and hemoglobin(p<0.01).In comparison between the two groups, plasma albumin and 24-hour urinary protein levels have no significant statistical differences.Conclusions:1 、 The Ig A nephropathy patients with nephrotic syndrome have worse renal function,higher lipid levels and lower hemoglobin level compared with the non-nephrotic syndrome patients.Grades Ⅱ and Ⅳ are more common in the nephrotic syndrome patients,the pathological distribution is bimodal.2、The Ig A nephropathy patients in nephrotic syndrome group with hematuria,renal insufficiency,hypertention and anemia,have more severe renal pathological lesion.3、Ig A nephropathy patients with nephrotic syndrome have heavier clinical and pathological manifestations.The severity of laboratory tests indicate severe renal pathological lesion,which has clinical significance in guiding treatment and prognosis.