Analysis Of The Clinical Features And Pathological Changes In 173 Primaty IgA Nephropathy

OBJECTIVE:To analysis the relationship between clinical features and pathological changes in 173 primary IgA nephropathy, and provide evidences for therapy.METHODS:173 IgA patients from the nephropathy department of Shandong Provincial Hospital affiliated to Shandong University was enrolled, and all of whom was diagnosed by renal biopsy during March 2008 to October 2010. We collected datas of the general information such as age, gender, course of disease, preceding infection, of the clinical feature such as edema, hypertension, gross hematuria and of the laboratory examinations such as proteinuria, microscopically RBC, albumin, TC, LDL, TG. The pathological results was classified by WHO classification standard and scored by Katafuchi rules. According to the 24 hours proteinuria level, we divided the patients into five groups:<0.3g/d,0.3-1.0g/d,1.0-2.5g/d,2.5-3.5g/d,≥3.5g/d, and detect the relationship between clinical manifestations and pathological changes of different groups.RESULTS:1.173 patients include male 97 and female 76 and the ratio is 1.28:1. It shows that the 20 to 50 year old group was predominant. The mean age at biopsy was 33.76±12.60. The median course of disease were 2.96 months.65 patients (37.6%) had preceding infection.2. According to the clinical features,32 patients (18.5%) was discovered by macrohematuria,4 patients (2.30%) had simple hematuria; the incidence of proteinuria with hematuria was 74.0%; the incidence of isolated proteinuria without hematuria was 23.10%.105 patients (60.7%) got edema.73 patients (42.2%) were companied with hypertension, and 31 patients (17.9%) with high urine-acid,75 patients (47.5%) with hypertriglycerideria,90 patients (57.0%) with high cholesteria, 16 patients (9.2%) with elevated blood glucose level. There were 13 patients (7.6%) who had developed into renal dysfunction before took the renal biopsy.3. Association among different clinical features:The MAP, serum creatine, urine acid, and proteinuria of male was significantly higher than those of female(P<0.05); the mean age, serum albumin, total cholesterol, urine acid, TG and MAP was significantly different among patients of different proteinuria groups. Patients with hypertension had higher serum creatine and larger amount of proteinuia than those without hypertension. There were more males than females in the hypertension group(P=0.002).4. Pathological type:the number of patients with WHO typeⅠ,Ⅱ,Ⅲ,Ⅳ,Ⅴwas respectively 17(9.8%),46(26.6%),54(31.2%),53(30.6%),3(1.7%). Both total cholesterol and serum creatine was different among different types(P<0.05).5. Immunoflurescence deposit:142(82%) cases had immunoflurescence deposit on the mesangial area,8(4.6%) on the capillary wall, and 23(13.3%) both on the mesangial area and the capillary wall. Cases with only IgA deposit were 66(38.15%), with both IgA and IgG deposit 19(10.98%), with both IgA and IgM deposit 71(41.04%), with IgA, IgM and IgG deposit 17(9.83%). The deposit of IgA was significantly different between different pathological types(χ2=14.729, P=0.022). Pathological IgA and C3 deposit had no relationship with serum IgA and C3.6. Pathological changes:Patients with masangial proliferation were 157(91.8%), with glomerular sclerosis were 86(49.7%), with segmental lesions were 122(70.5%), with tubulointerstitial lesions were 142(82.1%), with renal vascular injury were 32(18.5%).7. Associations between clinical and pathological indices:Glomerular sclerosis was significantly different among different age groups(P=0.001); There were significantly differences between cases of proteinura lower than 1.0g/d and cases of proteinuria higher than 3.5g/d in glomerular sclerosis, capsular adhesion, crescent formation, interstitial fibrosis, tubular atrophy, vascular lesion (P<0.05)It was severer in the hypertension group than the non-hypertension group in mesangial proliferation, glomerular sclerosis, interstitial filtration, interstitial fibrosis, tubular atrophy and vascular lesion(P<0.05). The mean arterial pressure(MAP) had significantly association with mesangial proliferation(Pearson indices=0.275, P=0.001). Patients with crescents formation had higher MAP(P=0.009). And the MAP also had significantly association with tubulointerstitial lesions(P<0.001).8. Nephtotic syndrome:Patients with NS were 30(17.3%), with mean age of 30.9±13.27 years. The ratio between male and female was 1.73:1. Compared with patients with only a large amount of proteinuria, the NS patients had higher edema incidence(P=0.037) and high cholesteria incidence(P<0.001), but had lower hypoalbumia incidence(P<0.05), lower mesangial proliferation(P<0.05), lower glomerular sclerosis(P<0.05), lower tubulomesangial lesions(P<0.05).CONCLUSIONS:1. The incidence ratio of IgA nephropathy between male and female was 1.28:1, and the common age range was 20 to 50 years old.37.6% patients had preceding infection. 18.5% patients were first discovered with painless macrohematuria.2. There was no significantly association among serum IgA, C3 and IgA, C3 deposit on renal tissues.3. The age, blood pressure and proteinuria at biopsy was found to be contributed to the pathological changes.4. NS patients account for 17.3%, and some of the pathological changes of NS patients were slighter than those of the patients with a large amount of proteinuria.