| Objective:The purpose of this study is to investigate the clinical and pathological features of IgA nephropathy with minimal proteinuria,and to analyze its correlation and related factors affecting renal function.Methods:1.Including 142 patients who were diagnosed with minimal proteinuria IgA nephropathy by he first renal biopsy from the Gansu Provincial Hospital from 2007 to 2020;2.To collect the clinical and pathological datas of the first renal biopsy;3.SPSS 24.0 software was used to statistically describe the clinical and pathological haracteristics of IgA nephropathy with minimal proteinuria,to analyze its correlation and related factors affecting renal function.Results:1.Clinical features:there were 79 males and 63 females,with a sex ratio of 1.26:1.The mean age at the time of renal biopsy was(35.4±12.4)years.The clinical manifestations of the occult onset of 128 patients(90.8%)were abnormal urinalysis,and 18 patients(12.7%) were recurrent gross hematuria,among which 83 patients(58.5%)were associated with prodromal infection at the time of onset,and upper respiratory tract infection was the most common.27 cases(19.0%),33 cases(23.2%)and 10 cases(7.0%)were already in stage 1,2 and 3 of chronic kidney disease;2.Pathological features:Lee’s grades II and III are the most common,with 58 cases(40.8%) and 68 cases(47.9%),respectively.54.2%of patients with mesangial cell proliferation>50%;51.4%of patients with segmental glomerulosclerosis;33.1% of patients with crescent formation;3.Clinicopathological correlation analysis:the quantitative value of urinary protein(P=0.033,r_s=0.179)and blood urea nitrogen(P=0.013,r_s=0.209)at 24 hours were weakly positive correlated with Lee grading.Urinary protein quantification at 24 hours(P=0.009,r_s=0.218), cystatin C(P=0.040,r_s=0.172)were weakly positive correlated with mesangial hyperplasia.Serum albumin(P=0.001,r_s=-0.280)and hemoglobin(P=0.020,r_s=-0.195) were negatively correlated with mesangial hyperplasia.Age(P=0.039,r_s=0.174)and cystatin C(P=0.004,r_s=0.238)were weakly positive correlated.eGFR(P=0.022,r_s=-0.192) and blood urea nitrogen(P=0.006,r_s=0.230)were correlated with tubular atrophy/interstitial fibrosis;4.Risk factors of renal injury:advanced age and hyperuricemia were independent risk factors for renal injury in IgA nephropathy with minimal proteinuria.Discussion:1.IgA nephropathy with minimal proteinuria may not be clinically mild,and may be accompanied by some active lesions;2.The clinical manifestations of IgA nephropathy with minimal proteinuria can predict the pathological severity.With the increase of urine protein content and blood urea nitrogen, Lee’s grading showed an aggravating trend;3.Elderly patients and hyperuricemia with IgA nephropathy with minimal proteinuria are more likely to have renal function damage.Objective: To evaluate the efficacy and safety of low dose glucocorticoid combined with ARB in the short-term treatment of IgA nephropathy with minimal proteinuria.Methods:1.53 cases of IgA nephropathy patients with minimal proteinuria were selected as the research objects,and the clinical and pathological data during renal biopsy were collected.2.The study subjects were randomly divided into a test group and a control group.The test group was given a small dose of hormone(prednisone 0.5mg / kg.d,maximum not more than 30 mg / d,oral,once a day)combined with ARB(valsartan 80 mg 1 time / day,tolerated patients,increase to 80 mg twice a day)treatment for 6weeks,thereafter reduce5 mg per month,gradually reduce the amount,when prednisone is reduced to 10 mg / d,maintain 3 months,and then reduced to 5mg / d for 3 months and then discontinued.And supplemented with calcium supplementation to prevent osteoporosis treatment.The control group was given ARB(valsartan 80 mg once per day,tolerated patients,increased to 80 mg twice a day)treatment.3.All subjects were followed up regularly every month for at least 3months,and clinical data,treatment plan,drug-related adverse reactions and corresponding treatment measures were collected.4.SPSS 24.0 was used for statistical analysis of the data.Results :1.There was no significant difference in clinical and pathological data before treatment between the two groups(P>0.05),suggesting comparability;2.Compared with before treatment,two groups of patients after 1 month of therapy of urinary protein were decreased,and the experimental group than the control group,urinary protein decreased more obvious difference was statistically significant(P?0.05);3.The two groups after 3 months of treatment in patients with urinary protein was in January were decreased,and the experimental group than the control group,urinary protein decreased more obvious difference was statistically significant(P?0.05);4.Safety evaluation: no patient withdrew from treatment due to hormonal side effects,and there were no cases of infection or hyperglycemia.Three patients had secondary hyperlipidemia and no serious hormone-related adverse reactions.Conclusion: Low dose glucocorticoid combined with ARB is more effective and safer than ARB alone in the treatment of IgA nephropathy with minimal proteinuria and have better security. |
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