| Objective:A comparative study of IgA nephropathy(IgAN)and Henoch-Schonlein pura Nephritis(HSPN)in children newly diagnosed and definitely diagnosed in the Second Hospital of Hebei Medical University(our hospital)in the past 10 years was carried out,and their clinical and pathological characteristics were summarized to explore the relationship between them.Methods:From January 1,2010 to December 31,2019,the newly diagnosed IgAN and HSPN children in the Second Hospital of Hebei Medical University were included.The clinical and pathological classification was based on the nephrology group standard of Pediatrics Branch of the Chinese Medical Association.The general conditions,clinical characteristics,clinical classification and pathological classification of the children at the time of admission were collected,and the retrospective comparative analysis was carried out,and the conclusion was drawn.Results:1.Statistical data From January 1,2010 to December 31,2019,237 IgAN children and 190 HSPN children were included.There was no significant difference in median age,age distribution,sex ratio and body mass index(BMI)between the two groups.2.Clinical manifestations and laboratory indicators(1)the course of disease before diagnosis in IgAN group was longer than that in HSPN group(P<0.05).IgAN group was significantly higher than HSPN group in the history of pre-infection(P<0.05).Clinical classification of the two groups of diseases: IgAN: nephrotic syndrome type 34.2%,hematuria proteinuria type 35.4%,acute nephritis type 2.1%,acute nephritis type 1%,isolated hematuria type 3.8%,isolated proteinuria type 1.3%,chronic nephritis type 22.8%;HSPN: nephrotic syndrome type 19.0%,hematuria proteinuria type 36.8%,acute nephritis type 11.6%,acute nephritis type 1%,isolated hematuria type 14%,isolated proteinuria type 10.5%,chronic nephritis type 14.2%;The proportion of hematuria,proteinuria and nephrotic syndrome in the two groups is large,and the difference in clinical classification of each group is statistically significant(P<0.05).(2)white blood cell count(WBC)and hemoglobin(HGB)in IgAN group were significantly lower than HSPN group(P<0.05).The creatinine level in IgAN group was higher than that in HSPN group(P<0.05).In serum immunology,there was no significant difference in serum IgA,Ig G,Ig M,C3 and C4 between the two groups,but the serum IgA of the two groups was higher than normal.3.clinical typing and pathological typingPathologic typing of IgAN and HSPN is the most common in various clinical types,with type II and type III being followed by type I and type IV.No type V in pathological typing and type VI in HSPN pathological typing were observed in the two groups.IgAN and HSPN have statistically significant differences in pathological typing between clinical types: hematuria and proteinuria,nephrotic syndrome and chronic nephritis(P<0.05).4.In renal pathology,there was no significant difference in glomerul osclerosis(including glomerular sclerosis ratio and segmental sclerosis ra tio),mesangial cell proliferation,loop necrosis and interstitial cell infiltr ation of IgAN(P>0.05).The formation of crescent and endothelial proli feration in IgAN group were lower than that in HSPN group,while tub ule atrophy in IgAN group was significantly higher than that in HSPN group,the difference was statistically significant.(P<0.05).In terms of i mmunofluorescence,both groups had IgA immune complex deposition i n mesangial region,most of which were accompanied by C3 deposition,often accompanied by Ig M deposition,few of which were accompanied by Ig G deposition,and few of which were accompanied by FRA and C1 q deposition.There was no significant difference in Ig G,Ig M,C3 an d C1 q in immunofluorescence between the two groups.The deposition of IgAN group in FRA was significantly lower than that in HSPN grou p,and the difference was statistically significant(P<0.05).There was n o significant difference in deposition types between IgA+C3,IgA+Ig M/C3 and IgA+Ig G.However,IgA+Ig M+Ig G/C3 in IgAN group was signifi cantly higher than that in HSPN group.According to Oxford classification of renal pathology,the mesangia l cells(M),endothelial hyperplasia(E),segmental glomerulosclerosis(S),renal tubular atrophy(T)and crescent formation(C)in the two groups were statistically analyzed.there was no significant difference in mesan gial cells(M)between the two groups.S1 and T1/2 in IgAN group we re significantly higher than those in HSPN group(P<0.05),while C1/2 and E1 were lower than those in HSPN group(P<0.05).Conclusion:1.The clinical manifestations of IgAN and HSPN are similar,but the pathological manifestations of IgAN are heavier than HSPN,which does not support the statement that both are the same disease and are more inclined to be two independent diseases.2.IgAN and HSPN in childhood need active treatment,which can reverse kidney damage and avoid the possibility of end-stage renal disease in adults.3.Oxford typing can be applied to renal pathological diagnosis of HSPN and can predict renal prognosis by homogenization comparison with IgAN. |
PDF Full Text Request