| Objective To analyze the clinical and pathological characteristics of Ig A nephropathy,evaluate the risk factors of renal dysfunction and the predictive value of pathological indicators in renal prognosis.Methods Retrospective analysis of 405 patients diagnosed with Ig A nephropathy in Shenzhen second people’s hospital,follow-up time is 12 months or more.Record pathological indicators according to the Oxford Classification,including mesangial hypercellularity(M),endocapillary hypercellularity(E),segmental glomerulosclerosis(S),tubular atrophy/interstitial fibrosis(T),and cellular or fibrocellular crescent(C).Evaluate the predictive value of the Oxford Classification in Ig A Nephropathy by the combined endpoint of end stage renal disease,creatinine doubling or 50% e GFR decrease.Results(1)General Information: 405 patients accounted for 48.1% of women.Most patients were concealed(80.7%).60.5% of patients with tonsil enlargement.Mean arterial pressure(MAP)was 99±14 mm Hg.The protein count was 1.1(0.06-14.6)g/d.The median follow-up time was 39 months.8.2% of patients entered end stage renal disease.(2)The relevance between the pathological indicators and clinical.(1)The proportion of M1、 E1 and S1 were 85.9%,35.3% and 30.9% respectively,the ratio of T1 and T2 were 18.3%,11.1%.There were 236 cases(58.3%)of C.The ratio of C1 and C2 was 48.2%,10.1%.(2)E、 S、 T and C were significantly associated with protein levels.E,S and T were significantly associated with MAP.S 、 T and C were significantly associated with the decrease of e GFR.(3)the relationship between pathological indicators and treatment showed that mesangial cell proliferation(M)and RAS blockers,glucocorticoids,immunosuppressive therapy was no significant correlation,suggested that mesangial cell proliferation was not the basis for the choice of doctors in treatment.Endothelial cell hyperplasia(E),focal segmental sclerosis(S),interstitial fibrosis(T)and crescent formation(C)were positively correlated with glucocorticoid and immunosuppressive therapy(E: r is 0.223,0.254;S: r is 0.129,0.208 respectively;T: r is 0.173,0.291;C: r is 0.21,0.299,endothelial cell hyperplasia,focal segmental sclerosis were not significantly associated with RAS blockers,however Interstitial fibrosis and crescent formation were negative association(r =-0.176,r =-0.105),which indicated Interstitial fibrosis and crescent formation were important basis for physicians to choose glucocorticoids and immunosuppressive agents,whereas interstitial fibrosis and crescent formation were cautions to use RAS blockers.(3)Risk factors for kidney injury of Ig AN: hypertension,uric acid,S and T were independent risk factors for kidney injury,however albumin and high-density lipoprotein may be a protective factor.(4)Kaplan-Meier survival curve showed that S、 T and C were associated with the progression of Ig A nephropathy excluded M and E.After single factor and multivariate Cox regression,only T was an independent risk factor for the progression of Ig A nephropathy.Conclusion(1)T of the Oxford Classification was independent predictive factor of combined end points in patients with Ig A nephropathy in this study.(2)Segmental glomerulosclerosis,and crescent proportions were closely related to the progression of Ig A nephropathy.(3)There was a significant correlation between the urinary protein level and the pathological indexes E、 S、 T and C of The Oxford Classfication,whereas MAP was significantly correlated with E、 S、 T,and e GFR was related to S、 T and C.(4)Endocapillary hypercellularity,interstitial fibrosis,tubular atrophy/interstitial fibrosis and crescent formation were important basis for physicians to choose glucocorticoids and immunosuppressive agents,whereas interstitial fibrosis and crescent formation were cautions to use RAS blockers.(5)Hypertension、 hyperuricemia、S、T were independent risk factors of kidney injured,whereas albumin and high density lipoprotein were protective factors. |
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