The Numbers Of Urine Podocyte In IgA Nephropathy And Its Related Clinical And Pathological Study

BACKGROUD:Resently,IgA nephropathy has become the world's most common primary glomerular disease,About 25%～40%patients developed to end stage renal failure gradually 10 years after diagnosis. Previous studies mainly focused on mesangial cell injury in IgA nephropathy,which is regarded as mesangial disease.A large number of researches have shown that podocyte injury can cause mesangial cell proliferation and mesangial matrix expansion,suggesting that podocyte and is closely related to the progress in IgA nephropathy.In the disease state,podocyte is the target to glomerular inflammatory diseases and non-inflammatory injury,injured podocyte detached from the basement membrane into the urine.The exposed basement membrane and the renal capsule parietal epithelial cell contact,resulting in capsular adhesion. Podocalyxin protein is cell-specific protein of podocyte and distributed in the cell surface.The anti - PCX antibody is the specific antibodies of podocyte and can be used to detect podocyte.Recently,literature has been reported in diabetic nephropathy,IgA nephropathy urine was detected in the patient cells,this article focused on Lee's various renal pathological classification of IgA nephropathy patients with urinary podocyte number of changes and related factors.Objective:Comparison of podocyte excretion in the urine with IgA nephropathy in Lee's grade renal pathology in each group and the expression changes of podocalyxin in each pathological groups are observed to explore the pathogenesis of IgA nephropathy.Methods:Collected blood and the morning urine specimen the day before renal biopsy from 43 cases patients with IgA nephropathy diagnosed by renal biopsy pathology,10 healthy volunteers as control. Take morning urine 100ml,300ul centrifugal sediment for smear. Respectively,Immunohistochemical staining with Monoclonal anti-Podocalyxin antibodies was used to detect urine podocyte cells.The amount of urinary podocyte was counted under the optical microscope (20 HP) and computer image analysis system was for the measurement of positive glomerular PCX optical density and optical density of each glomerular area divided by the calculated average value of optical density. Renal pathology of IgA nephropathy and classification based on Lee's Katafuchi semi-quantitative integration method.CysC in blood specimens was measured,using the MDRD formula to estimate glomerular filtration rate(GFR).General information and laboratory data(including 24-hour urine protein,Bun,Scr value) of patients were also collected. Relevance analysis was done on urinary podocyte number,glomerular expression of PCX with the pathological score and clinical and biochemical of the indicators.Results:1.No urine podocyte in normal control group;The positive rates of urine podocyte in IgA nephropathy patients is 82%.2.It is statistical significance in the number of urinary podocytes in each group(P <0.01).Comparison in each two groups indicate that: urinary podocyte number between Lee's gradeⅠandⅢ,Ⅳwas significantly(P <0.05);andⅡ,Ⅴgrade has no statistical significance (P> 0.05).urinary podocyte number between Lee'sⅡandⅣgrade level group was statistically significant(P <0.05);andⅢ,Ⅴgrade was no statistical significance(P> 0.05).The differences between Lee'sⅣandⅤgroups were statistically significant(P <0.05);The differences between Lee'sⅢandⅣ,Ⅴgroup was not significant(P> 0.05).The positive rate of urinary podocyte was high inⅡ,Ⅲ,Ⅳgroup(60%, 94%,100%),which is low in theⅠ,Ⅴgroup(50%,33%).3.glomerular PCX expression in Lee'sⅠlevel group's was brown and continuous along the glomerular capillary loop without distribution in renal tubular vesicles;In Lee'sⅡ,Ⅲ,Ⅳ,Ⅴ-class group,renal PCX expressed in varying degrees and express discontinuously,or part of the regional staining was significantly decreased,and some regional or segmental linear disappear,no expression in crescent formation areas.4.The differences of PCX glomerular expression in each group were significant(P <0.01).Comparison in each two groups indicate that: Differences of PCX expression between Lee'sⅠ,Ⅱ-class group andⅢ,Ⅳ,Ⅴlevel group,Lee'sⅢandⅤgrade level group group were statistically significant(P <0.05);Differences of PCX expression between Lee'sⅠ-class group and gradeⅡgroup,ⅢandⅣ-class group,ⅣandⅤgrade level group were not significant(P> 0.05).5.IgA nephropathy podocyte excretion in urine was negatively correlated with IgA nephropathy PCX glomerular expression(r=-0.494, p<0.01).6.Podocyte excretion in urine of IgA nephropathy patients have no correlation with glomerular and tubular points(P>0.05),Glomerular PCX expression in patients was negatively correlated with glomerular and tubular points(r=-0.560,-0.377;P <0.05).7.Urinary podocyte number in IgA nephropathy patients has positive correlation with 24-hour urinary protein(r=0.336,P <0.05),no correlation with GFR,Cysc,Scr,Bun(P>0.05).Glomerular PCX expression has negative correlation with 24-hour volume of urine protein (r=-0.387,p <0.01),positive correlation with GFR(r=0.313,P =0.046), and no correlation with Cysc,Scr,Bun(P> 0.05).8.Multiple linear regression analysis respectively Showed that glomerular podocyte score and urinary excretion in patients with IgA nephropathy is the independent factors of glomerular PCX expression with negative correlation(r =- 0.452,-0.381;p <0.01);PCX expression of glomerular podocyte is the independent factors of the urinary excretion with their negative correlation(r =- 0.456,p <0.01).Conclusions:1.Urinary podocyte have not been found in normal human urine.2.There is urinary podocyte discharge from IgA nephropathy patients,which is significant inⅡ,Ⅲ,Ⅳ-level lesions,and relatively less inⅠ,Ⅴ-level lesions.3.Urinary podocyte number in IgA nephropathy patients has a positive correlation with 24-hour urinary protein.4.Glomerular PCX in IgA nephropathy has a decreased expression.5.Glomerular PCX expression in IgA nephropathy has a negative correlation with tubular and glomerular pathology score,That is, Respectively,with the degree of mesangial proliferation,segmental damage,the ball sclerosis,interstitial fibrosis and tubular atrophy score was negatively related pathology.6.Glomerular PCX expression in IgA nephropathy has negative correlation with proteinuria levels.7.Podocyte excretion in urine and the degree of podocyte loss in renal tissue are related to each other.