The Correlation Analysis Of Segmental Glomerulosclerosis With Clinical Features And Pathology In IgA Nephropathy

OBJECTIVE: To investigate the correlation between segmental glomerulosclerosis and clinical features and pathology in primary IgA nephropathy(IgAN).METHODS: Retrospective analysis was conducted on patients admitted to The First Affiliated Hospital of Xiamen University from October 1,2016 to October 31,2020.These patients,aged between 18 and 70 years,were pathologically diagnosed with IgAN.Data were collected before patients underwent renal needle biopsy,including baseline demographic data,laboratory indicators,and renal pathology data.Renal pathology data,including Lee’s grade and Oxford typing(MEST-C),were obtained after consultation with pathologists in our hospital.All patients underwent renal ultrasound prior to renal puncture to determine the long and short diameter,width and cortical thickness of both kidneys.Then patients were divided into non-segmental glomerulosclerosis(S0)and segmental glomerulosclerosis(S1)groups according to the Oxford classification of renal pathology.Clinical indicators were compared between the two groups using t test or nonparametric test.The chi-square test was used for histopathological comparison.The correlation between clinical indicators and segmental glomerulosclerosis in IgAN was analyzed by Point-biserial correlation.The influencing factors were analyzed by binary Logistic regression method.Finally,ROC curve was used to assess the predictive effect of the relevant indicators on the progression in segmental glomerulosclerosis in IgAN.Results: 1.245 patients with IgAN included 140 females(57.14%)and 105 males(42.86%),with a male to female ratio of 1:1.33.There was no significant difference between the two groups in terms of age,sex ratio,body mass index and blood pressure(P>0.05).2.Point-biserial correlation was performed to show that IgAN segmental glomerulosclerosis was positively correlated with blood uric acid(UA),serum creatinine(Scr),blood urea nitrogen(BUN),24 h urine protein(24-UP),urine albumin-tocreatinine ratio(ACR),erythrocyte sedimentation rate(ESR),and complement C3(P<0.05),and estimated glomerular filtration rate(e GFR),albumin(Alb),and hemoglobin(HGB)were negatively correlated with segmental glomerulosclerosis(P<0.05),whereas it was negatively correlated with complement C4 and N-acetyl-β-Dglucosidase did not correlate(P>0.05),and the incidence of hypocomplementemic C3 was not statistically different between the two groups(P>0.05).3.There was no significant difference in renal ultrasound measurements between the two groups(P>0.05).4.There was a statistically significant difference between the two groups in the composition ratio of LEE’s classification(?2=73.131,P=0.001).The S1 group had a higher proportion of thylakoid cell hyperplasia,tubular atrophy or fibrosis and cellular/fibrous crescent pathological changes(P<0.05)compared to S0 group.However,there was no significant difference in the incidence of endothelial cell hyperplasia between the two groups(P>0.05).5.The difference in the composition ratio of chronic kidney disease stages between the two groups was statistically different(?2=11.168,P<0.05),with the S1 group having a higher proportion of stages 2-5 in chronic kidney disease than the S0 group.6.Baseline blood UA(OR=1.005,95%CI: 1.002-1.009,P=0.005),HGB(OR=0.976,95%CI: 0.958-0.993,P=0.006),ACR(OR=1.001,95%CI: 1.000-1.002,P=0.003)were significantly associated with segmental glomerulosclerosis in patients with IgAN.ACR,blood UA,HGB,Scr,e GRR and 24-UP were all predictive of progression in segmental glomerulosclerosis in IgAN,and the combination of these indices was of significant value in predicting the progression in segmental glomerulosclerosis in IgAN.The area under the curve corresponding to ACR was the largest among the individual indices(AUC:0.675±0.034,P<0.05),and therefore ACR was considered to be a relatively good comparative and reference index for predicting the progression in segmental glomerulosclerosis in IgAN.Conclusions: Baseline UA,HGB and ACR are significantly correlated with segmental glomerulosclerosis in IgA nephropathy.Correcting anemia by controlling serum UA level may help to slow down the progression rate of IgA nephropathy.IgAN segmental glomerulosclerosis is often associated with other pathological changes,and the corresponding LEE’s grade is high and severe.There is a certain relationship between LEE’s classification and Oxford classification,and the combined application of IgAN pathological classification may better guide the evaluation of the disease.The combination of HGB,serum UA,ACR,e GFR,Scr and 24-UP can effectively predict the progression in segmental glomerulosclerosis in IgAN.