The Study Of TCM Syndromes,Clinicopathological Features And Prognosis Of IgA Nephropathy With Hypertension

Objective:1.To analyze the TCM syndromes and clinic-pathological features of IgA nephropathy patients with hypertension;2.To investigate the prognostic risk factors of IgA nephropathy patients with hypertension.Methods:A total of 396 primary IgA nephropathy patients diagnosed by biopsy from January 2010 to December 2020 in Guangdong Hospital of Traditional Chinese Medicine were recruited.Patients were divided into hypertensive group(IgAN-HTN group)and normal blood pressure group(IgAN-NTN group)according to whether complicated with hypertension when performing the kidney biopsy.The general data,clinical and pathological data,TCM syndrome information and follow-up situation of the enrolled patients were collected and compared between the two groups..Kaplan-Meier survival curve was used to evaluate patients’ survival prognosis,and Cox regression model was used to analyze independent risk factors affecting renal progression in IgA nephropathy patients with hypertension.Results:A total of 396 patients with IgA nephropathy were recruited,including 189 males and 207 females(male to female ratio 0.91:1).Their median age was 33.9(26.6,43.6)years old.According to whether complicated with hypertension when performing the kidney biopsy,134 patients were divided into hypertension group(134 patient)and normal blood pressure group(262 patient).1.General informationCompared with the IgAN-NTN group,the IgAN-HTN group was more likely to be male and older,and had a higher proportion of smokers and alcoholics.In terms of inducement and first symptoms,the proportion of respiratory tract infection,gross hematuria and tonsil enlargement in the IgAN-NTN group was higher than that in the IgAN-HTN group,and the differences between groups were statistically significant(all P<0.05).There was no statistical difference in the course of disease between two groups.2.Clinical dataThe levels of systolic blood pressure,diastolic blood pressure,blood urea nitrogen,serum creatinine,blood uric acid,total cholesterol,triglyceride,blood low-density lipoprotein,hypersensitive CRP,blood complement C3,blood complement C4 and 24-hour urinary protein in IgAN-HTN group were significantly higher than those in IgAN-NTN group(all P<0.05).The levels of EGFR and serum IgM were significantly lower than those in IgAN-NTN group(P<0.05).There were no significant differences in fasting blood glucose,hemoglobin,total blood protein,serum albumin,serum IgA,serum IgG,urinary protein creatinine ratio,and urinary red blood cell count among two groups(P>0.05).In terms of CKD staging,the majority of patients in the IgAN-HTN group were CKD stage 3(31.34%),while the majority in the IgAN-NTN group were CKD stage 1(46.95%).There was statistical difference in CKD staging between the two groups(all P<0.05)Blood pressure was statistical significantly positively correlated with male,onset age,blood urea nitrogen,serum creatinine,serum uric acid,serum albumin,total blood cholesterol,complement C3,complement C4,24-hour urinary protein and CKD stage,and negatively correlated with EGFR(all P<0.05).3.Pathological dataIn terms of Oxford classification,the severity of renal tubule atrophy/interstitial fibrosis and crescent formation in the IgAN-HTN group was more serious than that in the IgAN-NTN group,and the differences between groups were statistically significant(all P<0.05).There were no significant differences in mesangial cell hyperplasia,capillary cell hyperplasia and segmental glomerular sclerosis between two groups.Spherical sclerosis and interstitial vascular injury were statistically significantly more serious in Igan-HTN group than in IganNTN group(all P<0.05).In terms of immunofluorescence,the proportion of IgA+IgM+Clq in the IgAN-HTN group was slightly higher than that in the IgAN-NTN group(P=0.047),and there was no statistical difference in the residual immunofluorescence distribution between two groups(all P>0.05).4.TCM syndromesIn IgA nephropathy,the most common syndromes were spleen-kidney-yang deficiency(53.79%),qi-yin deficiency(20.71%)and liver-kidney-yin deficiency(12.37%).The common side-syndrome were cold dampness(60.10%)and phlegm-dampness(36.63%).There was no significant difference between the main syndromes and side-syndrome between the IgAN-HTN group and the IgAN-TNN group,P>0.05 for all.5.Follow-up prognosisIn this study,the median follow-up time was 36.0(14.3,63.8)months,and the proportion of renal function progression in the IgAN-HTN group was significantly higher than that in the IgAN-NTN group(P=0.015).In terms of laboratory indicators after treatment,serum creatinine and 24-hour urinary protein levels in the IgAN-HTN group were significantly higher than those in the IgAN-NTN group,while eGFR was slightly lower than that in the IgAN-NTN group,with statistically significant differences(P<0.05).Kaplan-Meier survival analysis showed that the cumulative renal survival rate of the IgAN-HTN group was significantly lower than that of the IgAN-NTN group(LogRankχ2=9.412,P=0.002).Subgroup analysis showed that patients with hyperuricemia in IgAN-HTN group had a lower cumulative renal survival rate(LogRankχ2=4.715,P=0.030).6.Risk factorsMultivariate Cox regression results showed that diastolic blood pressure,blood urea nitrogen,serum creatinine,and severe renal tubule Crescent formation were common risk factors for renal end-point event in IgA patients,while hormone+immunosuppressive therapy was a protective factor for renal progression.Serum creatinine,severe tubule atrophy/interstitial fibrosis,and phlegm-dampness syndrome are independent risk factors for renal progression in patients with IgA nephropathy with hypertension.Conclusion:1.Hypertensive IgA nephropathy is more common in older、male patients,with a a higher proportion of smokers and alcoholics;The onset is more insidious,often with foam urine and edema as the first symptom.2.With the increase of blood pressure,the more serious of clinical manifestations such as blood urea nitrogen,serum creatinine,eGFR,24-hour urinary protein,etc.,the higher the CKD stage,the more serious of renal tubule atrophy/interstitial fibrosis,and the higher the proportion of crescent body,suggesting that the blood pressure level is closely related to the degree of renal injury.3.The syndrome types of traditional Chinese medicine are mostly spleen-kidney-yang deficiency syndrome,qi-yin deficiency syndrome and liver-kidney-yin deficiency syndrome.Compared with the spleen-kidney-yang deficiency syndrome and the spleen-kidney-yang deficiency syndrome,the diastolic blood pressure of the liver-kidney-yin deficiency syndrome is higher,and the renal interstitial vascular injury is more serious.4.Diastolic blood pressure,blood urea nitrogen,serum creatinine,and crescent formation are common risk factors for renal end-point event in IgA patients,while hormone+immunosuppressive therapy is a protective factor for renal progression.In patients with IgA nephropathy with hypertension,serum creatinine,tubule atrophy/interstitial fibrosis,and phlegm and dampness syndrome are independent risk factors for renal progression.