Clinic-pathological Analysis Of Primary IgA Nephropathy Patients In Different Age Groups

Background:IgAN is a group of diseases mainly by IgA or IgA with granular deposition of C3 into mesangial matrix. The clinical and pathological performance is diversity and changeability. Now changing with age, the relevant documents of what characteristics presenting are not much. And the traditional concept that IgAN occur in young and middle-aged men, well the prognosis is poor. The effection of gender on IgAN is still in dispute. In recent years, the influence of the clinical and pathological about age and gender on IgAN is more and more concerned.Objective:To study the clinical and pathological features of PIgAN patients in different age groups, to clarify the influence of age on PIgAN and to provide an evidence for judging the disease.Methods:A retrospective analysis of 135 cases of PIgAN patients (from January 2008 to March 2011) confirmde by renal biopsy examination in our hospital. On the basis of age is divided into 5 groups, to observe the clinical and pathological indicators, including gender, age, weight, duration, preonset manifestations, blood pressure, liver function, kidney function, blood fat, urinalysis,24-hour urine protein, immunoglobulin and complement, pathologic types, Lee's grade of pathological, TIL grade of tubulointerstitial damage and so.on. Summary the impact of PIgAN clinic-pathological on age. The measurement data was expressed as mean±standard deviation, the different between groups was analysed by analysis of variance, it was considered significantly. Statistical analysis of count data was analysed by x2 test, If P value<0.05 was considered statistically significant. Results:1.Clinical data analysis of 135 cases of PIgAN patients:1). General Information:The ratio of male and female was 1.25:1; the gender of all age groups in the incidence of no significant difference(P>0.05). Average age was 33±12 years; With 21～30 and 31～40 years old make up of the most number of cases, each the number of total cases of 32.6%,30.4%, compared with each age group (P＜0.01). Average weight was 66.2±13.2 kg; the lightest group was less than 20 years old and with significant difference (p＜0.05) between 31～40 and 41～50 years old groups. Average duration was 17.2±37.1 month, in 41～50 age·group was the longest, with significant difference(p<0.01)to other groups.2).Preonset manifestations:No obvious cause to preonset to a maximum of incentived, the total number of cases of 46.7%; and with clear infections cases of 22.2%, both with significant difference (p<0.01). Which accounted for 20.7% of respiratory tract infection, intestinal infections of 1.5% of cases, tonsillitis total of 2.2% of cases, accounting for 10.7% of respiratory tract infections.3).clinical classification and urine abnomaly characteristics:The most common type was asymptomatic abnormal urinalysis. Recurrent macroscopic hematuria common occoured in less than 20 years old and nephrotic syndrome in more than 51 years old. asymptomatic abnormal urinalysis and nephrotic syndrome high incidenced in male; in nephrotic syndrome type, male and female existed significant difference(p＜0.01). In women with edema in high incidenced, men and women with significant difference (p＜0.01). With increasing age renal insufficiency, hypertension, edema constitute a higher than the prodrome, and have the proportion has degressive tendency. Urine abnormal mainly hematuriain and proteinuria, all age groups with significant difference (p＜0.05). Isolated microscopic hematuria with high incidenced in women, gender with significant difference (p＜0.05) in Isolated microscopic hematuria.4).laboratory indices:IgA average comparison in all age groups was statistically significant(p＜0.05), it increased with age. And plasma albumin, total cholesterol, triglyceride, blood uric acid, creatinine, C3 and urine protin amount indices in all age groups were not statistically significant.2.135 cases of PIgAN patients with pathological data analysis:1). Optical microscope characteristics:The mesangial Proliferative glomerulonephritis was the most common type in histologieal change. TypeⅢandⅣwere the most well typeⅤandⅠwere relatively less in Lee's grading;There were non-significance difference(p>0.05) in each age groups. Men see more with typeⅣand typeⅢin women; gender in pathologic stage groups was significantly(p<0.05). TypeⅡwas the most one and typeⅣwas relatively less in TIL grading; there were significant difference(p＜0.05) with A,B,C three groups. The proportion of typeⅡwas increased with age, and high constitutes in men.2). Immunofluorescence characteristics:IgA main deposited on the mesangium area, fluorescence intensity grading++constituted the highest, pure IgA, with IgA and IgM, IgG, IgG+IgM; Pure C3, C4, Clq; with C3 and C4, Clq, C4+Clq; with C4 and Clq; No C3, C4, Clq and fibrinogen products in the constituent ratio of all age groups were not significantiy difference(P＞0.05). Pure C3 proportion of increased with age.Conclusion:1.The onset of PIgAN is Primary in young and middle-aged men, With no obvious cause the preonset of the majority, With increasing age Pre-onset manifestations patients gradually reduce proportion.2. The asymptomatic abnormal urinalysis type see more, mainly with hematuriain and proteinuria change, women with edema and isolated microscopic hematuria proportion more than male; Renal insufficiency, hypertension, edema patient increases with age increasing.3. The mesangial Proliferative glomerulonephritis is the most common type in histologieal change,typeⅢandⅣare the most in Lee's grading; Men see more with type IV and typeⅢin women, Gender on pathologic stage distribution have influence. TypeⅡis the most one in TIL grading, And with more than 40 years old increases with age interstitial damage gradually serious.4. IgA mainly deposition in the mesangium area, fluorescence intensity grading to++primarily, IgA average and pure C3 sedimentary proportion of increased with age increasing.5. PIgAN increased with age, its pathological change is more obvious and clinical expression is heavier, should do with clear renal biopsy to early diagnosis and treatment.