Analysis Of Prognostic Risk Factors In Patients With IgA Nephropathy With And Without Renal Insufficiency

Objective: 1.To investigate the effect of renal impairment on IgAN patients at baseline.2.To analyze the possible risk factors for the prognosis of IgAN patients with and without renal insufficiency,and provide evidence for early clinical intervention and improvement of patient prognosis.Methods:A single-center retrospective cohort study was used.A total of 583 patients with primary IgA nephropathy who were diagnosed and regularly followed up by renal biopsy in the Department of Nephrology,Ningxia Medical University from January 2008 to December 2017 were enrolled.The general clinical data,laboratory examination,pathological data and follow-up were collected.According to the data,all subjects were divided into two groups according to the Estimated glomerular filtration rate(eGFR)[calculated according to CKD-EPI formula] at 60 ml/min/1.73 m2.The differences in age,gender,pathology and other baseline data between the two groups were followed up to January 31,2019.The follow-up endpoints were creatinine doubling,acute cardiovascular events,end-stage renal disease(ESRD),renal replacement therapy,and death.Logistic regression analysis was performed to analyze the risk factors for the prognosis of patients with IgA nephropathy in the eGFR ≥60ml/min/1.73m2 group and eGFR<60ml/min/1.73m2 group.Results: 1.A total of 1041 patients with IgA nephropathy diagnosed by renal biopsy were included in the 583 patients with IgAN according to the admission criteria,including 308 males(52.83%)and 275 females(47.17%),with anaverage age of 36.03 ± 11.41 years,the mean follow-up time was 52.46 ± 32.66 months.2.Baseline comparison: eGFR was divided into two groups by60ml/min/1.73m2.Compared with eGFR≥60ml/min/1.73m2 group,patients with eGFR<60ml/min/1.73m2 group:(1)clinical,laboratory Index: patients with age,systolic blood pressure,diastolic blood pressure,mean arterial pressure,urea,serum creatinine,uric acid,24 h urine protein quantitation,high triglyceride,hemoglobin,serum albumin low(P <0.05);(2)pathology: patient system Membrane cell proliferation,segmental glomerular sclerosis or adhesion,interstitial fibrosis/tubular atrophy were relatively heavy(P<0.05).3.End point events: a median follow-up of 40.83 ± 33.17 months,a total of 92 cases of 583 patients with endpoint events.Kaplan-Meier survival analysis showed that the overall prognosis of patients with eGFR<60ml/min/1.73m2 IgAN was worse than IgAN patients with eGFR ≥ 60ml/min/1.73m2(Log Rank=73.015,P<0.01).Further logistic regression analysis indicated that age,repeated gross hematuria,systolic blood pressure,glomerular filtration rate,low albumin,triglyceride,interstitial fibrosis/tubular atrophy were risk factors for renal end point events in patients.4.Univariate analysis showed that in the baseline eGFR ≥60ml/min/1.73m2 group,the systolic blood pressure,diastolic blood pressure,serum creatinine and urea were higher in the end-point group than in the non-end-point group.Albumin Lower(P<0.05);interstitial fibrosis/tubular atrophy were more severe(P<0.05).In the baseline eGFR<60ml/min/1.73m2 group,patients in the end-point event group: were older,systolic blood pressure,higher triglyceride,and lower albumin than the non-end group.Mesangial cells Proliferation,segmental glomerular sclerosis or adhesion,interstitial fibrosis/tubular atrophy were more severe(P<0.05).Further logistic regression analysis indicated that the risk factors for renal end point events in eGFR ≥60ml/min/1.73m2 group were: interstitial fibrosis/tubular atrophy,and risk factors for renal endpoint in eGFR<60ml/min/1.73m2 group For age,triglycerides,mesangial cell proliferation.Conclusions:Age,hyperlipidemia,and mesangial cell proliferation are independent risk factors for prognosis in patients with baseline IgAN who have renal insufficiency,whereas systolic blood pressure,interstitial fibrosis/tubular atrophy are IgANs that affect baseline renal function.Patients with independent risk factors for prognosis.Intervention of hyperlipidemia and mesangial cell proliferation in patients with IgA nephropathy with renal insufficiency,intervention of systolic blood pressure,interstitial fibrosis/tubular atrophy in patients with normal renal function IgA nephropathy,and help to improve renal survival rate To delay the progression of the disease.