The Study Of The Constitution, Mucosal Inflammation, Chinese Medicine Syndrome Types And Clinical Pathology In IgA Nephropathy

ObjectiveThis study is to investigate the constitution, mucosal inflammation and their triggers, Chinese medicine syndrome types, clinical and pathological characteristics of patients with IgA nephropathy （IgA N）and to analysis their relationships in order to provide the scientfic basis and new ideas for the management of IgAN.MethodsThrough the cross sectional and retrospective study, we investigated262patients with IgAN in the Hospital of Guangdong provincical TCM hospital and the Third Hospital of Peking Universitiy between January2011and January2014. We collected the Chinese medicine syndrome types, clinical and pathological data, the constitution questionnaire and the mucosal inflammation and their possible triggers to explore their possible relationships.Results1. The demographic data:The ratio of male to female patients was1.03:1, the average age was34.53±12.75years old, and38.5%of the patients presented their disease at age of14-29years old. Asymptomatic abnormal urinalysis was the main initial presentation（43.1%）.The time between initial presentation and renal biopsy was18.43±29.03months.2. The constitution and its impact on the patients:The constitution of yin-yang harmony was the most common（40.5%）, followed by qi deficiency（31.3%）. Chronic periodontitis, scytitis and gastritis were more common in patients with the constitution of yin-yang harmony. Upper respiratory infection and the chronic tonsillitis were common in patients with the constitution of qi deficiency. The main triggers for skin and mucosal inflammation were exogenous evil,fatigue and stay up late.The Chinese medicine syndrome type of patients with the constitution of yin-yang harmony was mainly qi deficiency of spleen and kidney with turbid damp and blood stasis, while the constitution of qi deficiency was mainly the qi deficiency of spleen and kidney with damp-heat and blood stasis.24-hour urinary protein, cholesterol and triglyceride levels, the glomerular score, tubular-interstitial score and total score of patients with the constitution of yin-yang harmony and phlegm-damp were significantly higer than that of patients with the constitution of qi deficiency （P<0.05）. Patients with the constitution of yin-yang harmony and phlegm-damp and yang deficiency were commonly presented with CKD3-5clinically and Haas Ⅲ-Ⅴ pathologically.3. The mucosal inflammation and its impact on the patients:Upper respiratory infection, chronic periodontitis, scytitis were very common in patients wita IgAN. Patients with frequent mucosal inflammation were more commonly presented with asymptomatic abnormal urinalysis, CKD1-3clinically and Haas Ⅰ-Ⅲ pathologically. However, patients with non mucosal inflammation were more commonly presented with hypertention, mass proteinuria, chronic renal failure, CKD3-5clinically and Haas Ⅲ-Ⅴ pathologically.4. The Chinese medicine syndrome types and their impacts on the patients: Qi deficiency of spleen and kidney and blood stasis were the common type:69.1%,82.4%, respectively. Qi-yin deficiency type and the yin deficiency of liver and kidney type were more presented with CKD1-2. Qi deficiency of spleen and kidney, dampness syndrome and damp-heat syndrome were commonly distributed in CKD1, CKD2and CKD3;the turbid damp were commonly presented with CKD3-5. Blood stasis type was seen in every stage of CKD. Serum creatinine, urea nitrogen,24-hour urinary protein were significantly higher but GFR and serum albumin were significantly lower in patients with Yang-deficiency of spleen and kidney together with dampness syndrome or turbid damp than that of the other types （P<0.05）. Patients with turbid damp type were more commonly presented with Haas V and higher tubular-interstitial score, vascular score and total score than that of any others types（P<0.05）.5. The clinical and pathological relationships:Asymptomatic abnormal urinalysis （50.4%of the patients） and CKD1（48.5%） were the most common clinical Presentation. Haas Ⅲ was the most common pathological presentation（47.3%）. Asymptomatic abnormal urinalysis type and mass proteinuria type were mainly appeared in young patients and presented with CKD1₃clinically and Haas Ⅲ pathologically. Recurrent macroscopic hematuria was mainly appeared in chidren and young patients and presented with CKD clinically and Haas Ⅲ pathologically. Hypertention type was mainly appeared middle-aged patients and presented with CKD1-2clinically and Haas Ⅲ pathologically. Mass proteinuria type was mainly presented with CKD1-2clinically and Haas Ⅲ pathologically. Chronic renal failure type was mainly presented with CKD5clinically and Haas Ⅴ pathologically.6. Comparative study in patients with qi deficiency of spleen and kidney but different constitution types:Patients with qi deficiency of spleen and kidney and the constitution of yin-yang harmony presented with more non mucosal inflammation, more CKD3-4, higher than the latter in the level of serum creatinine, urea nitrogen, cholesterol, triglyceride, serum CH50and lower in GFR clinically and more Haas Ⅱ, Haas Ⅳ, higher glomerular score, tubular-interstitial score and total score, and higher deposition of IgG and FN but less deposition of IgA and C3pathologically as compared to those patients with the constitution of qi deficiency.ConclusionsOur stusy suggested that:1. IgAN onsets silently and asymptomatic abnormal urinalysis was the most common clinical type.2. IgAN patients with constitution of yin-yang harmony, phlegm-damp, yang deficiency were more severe both clinically and pathlogically than that of other Chinese medicine types,.3. IgAN patients with constitution of deficiency developed mucosal inflammation easily, indicating abnormal immunity in these patient populations.4. Frequent upper respiratory infection, chronic periodontitis and recurrent scytitis were common in patients with IgAN. IgAN patients without mucosal inflammation appeared to be more severe than the other patients.5.There were significant relationships among the Chinese medicine syndrome types, clinical presentation, CKD stage, biochemistry, Haas classification and Katafuchi integration. Qi-yin deficiency type appeared to be the least sever type followed by qi deficiency of spleen and kidney and yang deficiency of spleen and kidney with turbid-damp type and dampnese syndrome which was most severe type in our study. However, possibility remains that there is disaaaociation between clinical presentation and pathological changes..6. The risk of declined renal function and hypertention increase with age.7. IgAN patients with qi deficiency of spleen and kidney and the constitution of yin-yang harmony had higher serum CH50level, low incidence of mucosal inflammation, increased risk of declined renal function and more sever renal pathlogical changes than that of patients with qi deficiency of spleen and kidney and the constitution of qi deficiency.