| Objective IgA nephropathy is the most common cause of primary glomerulonephritis worldwide,with a variety of clinical manifestations ranging from asymptomatic microscopic hematuria to a more severe course characterized by continuous progression and rapid deterioration of renal function leading to kidney transplantation or dialysis.The pathogenesis of IgA nephropathy remains largely elusive,and the identification of risk factors is valuable,and combinations of different risk factors are useful.Several clinical features have been established that are associated with poor prognosis,especially age,hypertension,proteinuria,and glomerular filtration rate(GFR).Several clinical parameters,such as hypertension,elevated serum creatinine,and ?1g/24 h proteinuria,have been shown to be strong indicators of severe disease progression and to be good predictors of the risk of clinical progression.Because IgA nephropathy is a highly heterogeneous disease with a variety of risk factors for renal function decline,there is currently no mature predictive tool for widespread clinical use.Previous studies have suggested that proteinuria followed up to 2 years and blood pressure data are clinically significant and can be predicted.This approach has limited clinical practice given the current guidelines,which suggest that treatment decisions are primarily based on clinical features.To overcome this limitation,newer predictors combine clinical data from biopsies with pathologic features to adjust patients' treatment earlier and help maintain kidney function.This clinical trial statistics nearly five years clinical data of IgA nephropathy patients in our division.We expand clinical indicators on the basis of proteinuria,blood pressure,kidney function,further index to evaluate the clinical and pathological classification of Oxford MESTC score.We evaluated the correlation between clinical indicators and histological characteristics at renal biopsy and risk factors leading to pathological severity of the Oxford classification to determine the predictive power of clinical indicators and histological characteristics at renal biopsy for IgA nephropathy.The correlation differences between clinical and pathological Oxford subtypes of MESTC scores were examined by stratification according to age and gender.It provides clinical basis for nephrologists to predict the renal function of patients and decide whether to administer hormone immunosuppression therapy,so as to improve the efficiency and better improve the prognosis of patients with renal disease.Methods1.A total of 278 patients with primary IgA nephropathy without complications were selected from January 2016 to February 2021 who were admitted to changhai hospital for the IgAN diagnosis confirmed by renal needle biopsy for this retrospective study.Include patients older than 14 years old,and renal biopsy confirmed as the primary IgA nephropathy,the first biopsy patient,eliminate secondary IgA nephropathy,such as systemic lupus erythematosus(SLE),allergic purpura nephritis,hepatitis B virus associated glomerulonephritis,crohn's disease,liver disease,tumor,and thrombotic thrombocytopenic purpura,eliminate primary IgA nephropathy with other disease and pathological damage,such as IgAN with membranous nephropathy,complicating acute tubular necrosis,merging diabetic nephropathy,merging hypertension nephropathy etc.And excluded those who were transplanted renal biopsy and repeated renal biopsy patient.Records of renal biopsy in patients with age,the onset age,body mass index,blood pressure,including systolic pressure,diastolic blood pressure,and 24-hour urine protein quantitative,urinary NAG,urine IgG,beta 2 microglobulin,hemoglobin,blood cholesterol,blood triglycerides,low density lipoprotein cholesterol(LDL-c),serum creatinine,blood serum uric acid,serum IgG,IgA,IgM,serum IgE,serum C3,C4 and serum estimated glomerular filtration rate(MDRD formula).The degree of renal pathologic lesions was assessed according to MESTC score of Oxford subclassification,including mesangial cell hyperplasia(M0/1),increased capillary cells(E0/1),segmental glomerulosclerosis and \ or adhesion(S0/1/2),tubule atrophy/interstitial fibrosis(T0/1/2),and crescent formation(C0/1/2).The single factor data were grouped by each pathological classification,and the analysis variables were clinical indicators.Continuous data(measurement data)satisfying the normality test and homogeneity test of variance should be analyzed of variance(the t-test of dichonomic data is equivalent to analysis of variance).The dichotomous variables(four tables)were tested by chi-square test(?2).When the target variable is grade data,Kruskal-Wallis H test(non-parametric test)is used.Both Kruskal-Wallis H test and Kappa consistency test were used for bidirectional order grade data.Binary Logistics regression is used for the four pathological classifications of M,S,E and C(since there is only one observation of C in score 2,it cannot pass the parallel line test,so ordered Logistics regression cannot be used for C),and ordered Logistics regression is used for T.In addition,M,S,E,and C also use hierarchical regression.2.A total of 278 patients with primary IgA nephropathy without complications were selected from January 2016 to February 2021 who were admitted to our hospital for the IgAN diagnosis confirmed by renal needle biopsy.The inclusion and exclusion criteria were the same as in Part I.Patients were grouped according to age,and divided into(1)young group: age <30 years old;(2)middle age group: 30 years old ? age ?50 years old;(3)old age group: age >50 years old.Data were grouped by age group and each pathological type for single factor,and the analysis variables were clinical indicators.Other statistical analyses are the same as in Part I.3.A total of 278 patients with primary IgA nephropathy without complications were selected from January 2016 to February 2021 who were admitted to our hospital for the IgAN diagnosis confirmed by renal needle biopsy.The inclusion and exclusion criteria were the same as the first part.Patients were divided into(1)male group;(2)female group.Data were grouped by gender and each pathological type for single factor,and clinical indicators were used as the analysis variables.Other statistical analyses are the same as in Part I.Results One-way analysis of variance showed that the pathological changes of M were significantly correlated with hemoglobin,urinary NAG,serum creatinine,serum IgG and serum IgA(all P<0.05).Multivariate logistic regression analysis found that M was only significantly correlated with urinary ?2 microglobulin(P=0.009),and the correlation was different in age and gender groups.In the multivariate logistic regression analysis,it was found that E was well correlated with 24-hour urinary protein(P=0.001),serum creatinine(P=0.012),EGFR(P=0.012)and serum C3(P=0.042),and these clinical indicators were considered as clinical risk factors for E.There were significant differences in the correlation among different age groups and gender groups.No matter in univariate analysis or multivariate analysis,S was significantly correlated with age,and the correlation was significantly different for different age groups and gender groups.T pathological changes both single factor analysis and factor analysis were found have good correlation with a lot of clinical indexes,multiple factors regression analysis of the clinical risk factors are: 24 hours urinary protein,urinary quantitative beta 2microglobulin,serum creatinine,serum IgA,all the correlation between the risk factors and T pathological changes had age,gender differences.In univariate analysis of variance,C was shown to be correlated with 24-hour urinary protein quantification(P=0.013),serum creatinine(P=0.000)and glomerular filtration rate(P=0.039).Logistics regression analysis was significantly correlated with 24-hour urinary protein quantification(P=0.005).The correlation also had difference in age and gender.Conclusions Some clinical indicators which were respectively correlated with mesangial cell hyperplasia(M),cells increased in blood capillary(E),segmental glomerular sclerosis and \ or adhesion(S),tubular atrophy/fibrosis(T),the crescent formation(C)at the first renal biopsy time were respectively as the risk factors of he pathological changes M,E,S,T,C.These clinical risk factors related to M,E,S,T,C had gender and age differences.Clinicians need to fully assess patients' clinical and pathological factors,combined with age and gender,and predict the risk of disease progression in an early stage,so as to develop individualized treatment plans. |
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