Study On The Associations Of Clinical Prognostic Indices With The Renal Pathological Lesions In 903 Cases Of IgA Nephropathy

Objective To explore the characteristics of clinical prognostic indices and renalpathological lesions, as well as the associations between them.Method The clinical and renal biopsy pathological data of 903 cases with IgAnephropathy were analyzed retrospectively..Result 1.General indices. 903 cases including male 588, female 315, and theratio of male to female was 1.87 : 1. The mean age was 30.20 ?11.88 years.The 11-40 year-old group was most prominent. 2. Characteristics of clinical indices. Percentage of cases with clinical gross hematuria was 29.4%, with only microhematuria 7.3%, with urinary protein excretion less than 0.5 g /d 13.8%, with urinary protein excretion within 0.5 - 1.0 g /d 17.7 %, with urinary protein excretion within 1.0-2.0 g /d 20.6 %, with urinary protein excretion within 2.0-3.0 g /d 11.1 %, and with urinary protein excretion more than 3.0 g /d (without nephritic syndrome) 17.8 %. There was a tendency of urinary protein excretion increase with age. The percentage of cases with nephritic syndrome was 10.6 %, among which the under-10-year-old group and the over-61-year-old group were most prominent. The percentage of cases with hypertension was 37.3, with renal insufficiency 18.4 %. The percentage of cases with hypertension or renal insufficiency in each age-stage group both increased with age. 3.Characteristics of IgA nephropathy SMK grade. Among the 903cases, percentage of cases diagnosed as IgA nephropathy SMK grade I was 9.0 %, grade II 19.5 %, grade III 28.9 &, grade IV 33.6 %, grade V 9.0. The grades of cases increased with age. ^Characteristics of renal biopsy pathological lesions. The scores increased with age of lesions of global glomerulosclerosis, interstitial fibrosis, interstitial inflammatory infiltration, tubular atrophy, and vascular injury, while the scores of mesangial proliferation, segmental sclerosis, capsular adhesion, and crescent formation did not increased significantly.5.Characteristics of the immunoflurescence depots in glomeruli. Among 903 cases, percentage of cases with only IgA deposit was 12.0 %, with both IgA and IgG deposits 38.1 %, with both IgA and IgM deposits 78.9 %, with both IgA and complement C3 deposits 86.8 %, with both IgA and complement C4 deposits 16.8 %, with both IgA and complement Clq deposits 37.7 %, with both IgA and FRA 87.9 %. As age increased, percentage of cases with only IgA deposit decreased significantly, while percentages of cases with IgA deposit combining IgM, C3, or FRA increased significantly.6.Associations between the clinical indices and the pathological grades. As the pathological grade increased, the urinary protein excretion increased, and the percentage of cases with higher level of hypertension or serum creatinine rised. Our results also showed that among cases with IgA nephropathy grade III-V, urinary protein excretion of 30% cases was under 1.0 g/d.Conclusion In IgA nephropathy, the characteristics of clinical manifestation and renal pathological lesions differed apparently between different age-stage groups. As the age increased, there were tendencies of increasing in both clinical and pathological indices. Our result indicated that age may be animportant factor that may affect the prognosis of IgA nephropathy. The IgA nephropathy grades were in accordance with the levels of urinary protein excretion, hypertension, and serum creatinine on the whole, but still the urinary protein excretions of 30 % cases with IgA nephropathy grade III-V were less than 1.0 g/d, which should be paid attention to.