Clinical Efficacy Of Spironolactone On IgA Nephropathy And TCM Syndromes Of IgA Nephropathy Association Study With Oxford Classification

Clinical Efficacy of Spironolactone on IgA Nephropathy and TCM Syndromes of IgA Nephropathy Association Study with Oxford ClassificationObjective:To explore the effect of spironolactone on reducing urinary protein in patients with IgA nephropathy,and comprehensively evaluate the safety of spironolactone.A correlation study was conducted between the TCM syndromes of the included patients and various indicators of Oxford classification,in order to analyze the regularity of renal prognosis in patients with different syndromes of IgAN.Method:（1）Clinical observation of spironolactone on IgA nephropathyPatients who were diagnosed with primary IgAN by renal biopsy pathology combined with clinical manifestations were included.The intervention therapy in the control group was routine treatment of IgA nephropathy such as RAAS inhibitors,combined with glucocorticoids if necessary,and the experimental group was treated with spironolactone on the basis of the control group..The clinical data at four time points of baseline,3 months of treatment,6 months of treatment,and 12 months of treatment were collected and analyzed.The changes of urinary protein and glomerular filtration rate in the two groups were retrospectively analyzed and compared,and the incidence of adverse reactions such as hyperkalemia,breast development or breast tenderness,and hypotension were observed.Result:（1）Clinical dataBefore treatment,there were no significant differences between the experimental group and the control group in terms of age,gender,BMI,laboratory indicators such as 24hPro,serum K,and Oxford classification of renal pathology,and they were comparable.（2）Clinical efficacy of spironolactone on IgA nephropathy 1.The 24hPro of patients in the experimental group and the control group after 3 months,6 months and 12 months of treatment was different from the baseline.Comparing the patients in the experimental group and the control group before and after treatment,it was found that 24hPro in both groups showed a downward trend after 12 months of treatment,and the decrease in the experimental group was more significant than the baseline level,P<0.05.Subgroup analysis found that the patients in the CKD1-2 stage and 24hPro>1g subgroup in the test group had a more significant decrease in 24hPro compared with the baseline level after 12 months of treatment;although the reduction in CKD3 stage patients was not statistically significant,the magnitude of the decline was significant.still larger than the control group.2.Separately analyze the eGFR of the two groups of patients before and after treatment,and found that the eGFR of the patients in the experimental group increased after 3 months of treatment,but decreased after 6 months of treatment,and the intervention treatment was extended to 12.Monthly eGFR decreased significantly from baseline（P=0.007）.After 3 months of treatment,the eGFR in the control group also showed an upward trend compared with the baseline level.After 6 months of treatment,the eGFR decreased significantly（P<0.05）,but when the intervention treatment was extended to 12 months,the eGFR rose again,but it was still significantly lower.at the baseline level,（P=0.005）.Subgroup analysis found that compared with baseline levels,both groups of patients with CKD stage 1-2 had a significant reduction in eGFR after 12 months of treatment,while the control group had a greater decline.The eGFR of the control group patients in CKD stage 3 was significantly increased compared with the baseline level after 12 months of treatment,although the experimental group also showed an increasing trend,but it was not significant.In the 24hPro≤1g subgroup,the eGFR of the patients in the experimental group decreased significantly compared with the baseline level after 12 months of treatment,while the control group increased significantly,P<0.05.3.The two groups of patients were compared before and after their own intervention treatment.Taking the baseline as the starting point,the serum K of the two groups of patients continued to increase after 3 months,6 months and 12 months of treatment,and the increase in the control group was more obvious..There was no significant difference in serum K between the experimental group and the control group after 12 months of treatment（4.30±0.38mmol/l VS 4.32±0.32mmol/l）,P=0.86.4.In the experimental group,3 patients（7.30%）had hyperkalemia,3（7.30%）had breast hyperplasia or pain,and 1（2.4%）had hypotension.In the control group,1 patient（2.50%）developed hyperkalemia,and no patient developed mammary gland hyperplasia or pain or hypotension.There was no statistical difference in the incidence of adverse events of hyperkalemia,breast hyperplasia or pain,and hypotension between the two groups（all P>0.05）.（3）Association between TCM syndromes of IgA nephropathy and Oxford classification1.Syndrome distribution:The included 81 patients with IgA nephropathy were all classified according to the TCM syndrome differentiation of Prof.Wang Yongjun.Among them,38 patients had two syndrome types,and they were included in different syndrome types for analysis.There were 119 cases in total.type.Among them,45 cases were of kidney deficiency syndrome,22 cases of rheumatism syndrome,25 cases of liver wind syndrome,and 27 cases of blood stasis syndrome.2.Correlation study between TCM syndromes of IgA nephropathy and Oxford classification:the proportion of El and T1/T2 pathological types in kidney deficiency syndrome was significantly lower than that in non-kidney deficiency syndrome（E:P=0.03,T:P=0.023）.The proportion of T1/T2 pathological types in rheumatic syndrome was significantly higher than that in non-rheumatic syndrome（P=0.036）.The proportion of T1/T2 and C1/C2 pathological changes in liver wind syndrome was significantly higher than that in non-liver wind syndrome（T:P=0.031,C:P=0.032）.The proportion of pathological types of S1,T1/T2 and C1/C2 in blood stasis syndrome was significantly higher than that in non-stasis bi syndrome（S:P=0.047,T:P=0.000004,C:P=0.000002）.Conclusion:（1）Clinical efficacy of spironolactone on IgA nephropathy1.IgA nephropathy patients with spironolactone intervention on the basis of conventional treatment can reduce urinary protein to a certain extent,especially in IgA nephropathy patients with CKD1-2 stage and 24hPro>1g.2.Spironolactone can reduce glomerular blood perfusion to a certain extent,resulting in the decrease of eGFR,but the long-term efficacy needs further observation.3.There was no significant difference in the incidence of adverse reactions between the two groups,and the addition of spironolactone did not significantly increase the risk of hyperkalemia,breast hyperplasia or pain,and hypotension in the experimental group.（2）Association between TCM syndromes of IgA nephropathy and Oxford classification1.According to Professor Wang Yongjun’s syndrome differentiation of patients with IgA nephropathy,the prognosis of patients with kidney deficiency syndrome is good,and the prognosis of patients with rheumatism syndrome,liver wind syndrome and blood stasis syndrome is poor.2.For patients with rheumatism syndrome and liver wind syndrome,on the basis of conventional treatment,spironolactone can relieve foamy urine and improve clinical symptoms.