The Effect Of Blood Pressure Rhythm Change On Clinicopathology In Patients With IgA Nephropathy With Hypertension

Objective:to investigate the clinical effects and pathological features of blood pressure rhythm changes on primary IgA nephropathy patients with hypertension.Methods:a total of 228 patients with IgA nephropathy with hypertension who were hospitalized in the first affiliated Hospital of Xinjiang Medical University from January2009 to December 2020 were selected.According to the results of ambulatory blood pressure measured during hospitalization,the above patients were divided into nocturnal blood pressure normal group and nocturnal hypertension group,and the differences of clinical examination indexes and pathological examination results between the two groups were compared.Results:among the 288 patients,there were 159 patients with nocturnal hypertension.The prevalence rate of nocturnal hypertension in IgA nephropathy with hypertension was 69.7%,most of which were male.In nocturnal hypertension group,the morbidity of hypertension,serum uric acid,nocturnal mean systolic blood pressure,nocturnal mean diastolic blood pressure,morning mean systolic blood pressure,morning mean diastolic blood pressure,blood urea nitrogen,triglyceride,serum creatinine and24-hour urinary protein quantification were[120（75.5）%],[（385.00±119.69）umol/L],[（133.33±14.28）mm Hg],[（85.49±9.59）mm Hg],[（135.97±14.34）mm Hg],[（89.65±10.80）mm Hg],[6.20（4.80,8.13）umol/L],2.08（1.54,3.09）umol/L],[94.00（73.09,127.00）umol/L],[2.18（0.690,4.94）g/d].It was higher in the nocturnal normotensive group than in the nocturnal normotensive group[6（8.7）%,（24.19±3.37）kg/m2,356.49±84.89umol/L,109.17±7.22mm Hg,66.57±4.56mm Hg,115.14±10.89mm Hg,74.39±7.75mm Hg,5.40（4.45,6.55）umol/L,1.74（1.09,2.39）umol/L,82.50（65.90,98.00）umol/L,1.11（0.55,2.31）g/d].On the contrary,e GFR[（80.27±30.57）ml/(min·1.73m²)]was lower than that in the nocturnal blood pressure normal group[（90.45±29.06）ml/（min·1.73m²）]（P<0.05）,and there was significant difference in the proportion of normal renal function and abnormal renal function between the two groups.The proportion of IV-V grade in Lee pathological grade in nocturnal hypertension group was higher than that in nocturnal blood pressure normal group,the proportion of renal tubule atrophy/interstitial fibrosis（T1+T2）in Oxford pathological type was higher than that in moderate and severe lesion group（T1,T2）than that in mild lesion group（T0）,the levels of blood urea nitrogen,24-hour urinary protein,serum creatinine,serum uric acid and serum C4 were higher,but the level of e GFR was lower（P<0.05）.The quantity of24-hour urinary protein and glomerular sclerosing rate may be independent risk factors for IgA with elevated nocturnal blood pressure.Conclusion:1.The prevalence of elevated nocturnal blood pressure is higher in patients with primary IgA nephropathy with hypertension,and most of them are male patients.2.The clinical manifestation and Lee’s grade of IgA nephropathy patients with nocturnal hypertension were more severe.3.In Oxford classification,there was significant difference in renal tubular atrophy/renal interstitial fibrosis.4.24-hour urinary protein quantity and glomerular sclerosing rate are independent risk factors for IgA with elevated nocturnal blood pressure.Control of urinary protein and nocturnal blood pressure have guiding significance for delaying renal function and prognosis of IgAN.