Clinical And Pathological Features Of Patients With IgA Nephropathy With Podocytopathy

Objective:This study analyzed the clinical and pathological characteristics of patients with IgA nephropathy with podocytopathy,in order to improve the understanding of podocytopathy in mesangial disease IgAN,alter the research thinking pattern on this disease,and provide theoretical basis for IgAN treatment targeting podocytes.Methods:We collected the basic data,laboratory results and pathological data(light microscopy,electron microscopy and immunofluorescence)of 213 patients diagnosed as IgA nephropathy by pathological biopsy of renal tissue from January 2018 to June 2019 in the Department of Nephropathy,Union Hospital,Wuhan.The subjects were divided into two groups based on pathological lesions,podocyte hypertrophy / apical lesion group(n = 136)and without podocyte hypertrophy / apical lesion group(n=77).In the subgroup,after matching the M,E and C pathological parameters(M0E0C0),the subjects were divided into podocyte hypertrophy / apical lesion group(n = 25)and without podocyte hypertrophy / apical lesion group(n=42).Rank-test(man-whitney),X-test and other statistical methods were used to retrospectively compare and analyze the clinical data and pathological data of different groups to explore the clinical and pathological characteristics of IgA nephropathy patients with podocytopathy,so as to improve the understanding of podocytopathy in IgAN patients.Results:The average age of IgAN patients included in this study was 34.9 ± 11.5 years,among which 69.5% were no elder than 40 years old,and the male to female ratio was 1: 1.2.8.8%(20 cases)had gross hematuria,and 6.1%(13 cases)were characterized by nephrotic syndrome,among which 11 cases(84.6%)bore podocyte hypertrophy podocyte hypertrophy / apical lesion.14.1%(30 cases)24h urine protein quantification was greater than 3.5g,of which 25 cases(83.3%)were in the podocyte hypertrophy / apical lesion group.37.6%(80 cases)had hypertension.IN the group with podocyte hypertrophy / apical lesion,patients had higher levels of 24 h urine protein quantification,creatinine and cystatin than the group without podocyte hypertrophy / apical lesion.,with lower serum albumin levels,and the difference was statistically significant(p <0.05).The incidence of massive proteinuria in the podocyte hypertrophy / apical lesion group was 18.4%,which was much higher than the control group,and the difference was statistically significant(p <0.05).The incidence of hypertension was similar in the two groups(p> 0.05).In terms of pathological changes,the respective score of Oxford classification M,E,S,T and C in the group with podocyte hypertrophy / apical lesion was higher than that in the group without podocyte hypertrophy / apical lesion.Moreover,the global sclerosis,segmental sclerosis and acute lesions were more severe in the group with podocyte hypertrophy / apical lesion,and the difference was statistically significant(p <0.05).Vascular lesions were similar between the two groups(p> 0.05).Only 18.4% of the patients with podocyte hypertrophy / apical lesion had mild pathological changes(M0E0C0),while more than half of the patients without podocyte hypertrophy / apical lesion had mild pathological changes(M0E0C0).In the subgroup analysis,after matching the pathological parameters of M,E,and C(M0E0C0),the group with podocyte hypertrophy/apical lesion was more chronic,still bearing higher T score,more significant segmental sclerosis and interstitial fibrosis than that in the group without hypertrophy / apical lesion.Conclusions:IgA nephropathy is regarded as a mesangial disease,but podocytes play an important role in disease progression.Patients with podocytopathy have high levels of proteinuria,severe pathological changes and higher degree of chronicity.Podocytopathy is not only an important adverse prognostic factor for IgAN,but also an important target for future drug therapy.To slow down the progression of IgAN,we should not only diminish the activity of mesangial cells and alleviate the inflammatory response,but also maintain the function of podocytes and reduce the apoptosis and loss of podocytes...