| ObjectiveTo study the clinical features and pathological changes of1gA nephropathy (IgAN) and their relationships, providing help for diagnosis, treatment and prognosis evaluation.Methods793cases admitted to the Second Xiangya Hospital of Central South University for renal biopsy between May2008and April2013and diagnosised with IgAN were reviewed. The whole clinical and pathological informations were analyzed by SPSS17.0.Results1. Clinical information of793cases with IgAN(1) There were349males and444females (male:female ratio1:1.27). IgAN generally occurred in young adults (32.9±12.1years old) and mostly happened in workers, followed by farmers and students. The mean disease courses was20.2±37.7months and body weight58.9±10.77kg. Migrant worker was the most common occupation (17.7%), followed by farmer (17.2%) and student (14.2%)(2) Among IgAN diversity precursor characteristics, the most common was health examination (34.9%), followed by edema (27.7%),.(3)793cases wre classified into6clinical typed, including isoloated microscopic hematuria (I-H)(58,7.3%), recurrent gross hematuria (R-GH)(105,13.2%), abnormal urinalysis (U-ab)(327,41.2%), mass proteinuria (MP)(125,15.8%), hypertention (HP)(96,12.1%)and chronic renal failure (CRF)(82,10.3%). Among them, U-ab was the most common (41.2%); R-GH was younger than total cases (P<0.01,28.9±10.2vs.32.9±12.1year) while CRF was older (P<0.01,37.7±13.4vs.32.9±12.1); I-H and R-GH were more commonly occurred in female (P<0.01,1:3.46vs.1:1.27and1:2.39vs.1:1.27, res.) while MP and CRF in male (P<0.05, P<0.01,1:0.87vs.1:1.27and1:0.58vs.1:1.27, res.).(4)40.4%,37.5%and33.9%of the cases presented with higher level of total cholestero (CHOL) and triglyceride (TG) and low level of serum albumin.26.2%of the patients had increased level of serum uric acid (UA) and part of the cases with increased levels of serum creatinine (Scr) and blood urea nitrogen (BUN). Most of cases had normal levels of serum IgG, IgA and C4, while35.1%presented with lower serum C3. Urinary findings showed most of patients presented with hematuria and/or proteinuria.2. Pathological data of793cases with IgAN(1) According to WHO definition, the most frequent histological pattern of glomerular injury was focal and/or segmental glomerulosclerosis (FSGS), found in57.4%of patients. By using Oxford Classification, the most common pathology diagnosis was M0S1E0T0(25.6%), of which segmental glomerular sclerosis (S1) accounted for58.01%. All the cases presented with mesangial cell proliferation and mild proliferation was the most common.79.8%、86.1%and84.9%of the cases presented with glomerulosclerosis, interstitial fibrosis and tubular atrophy respectively, most of the cases with renal interstitial inflammation (76.4%) and vasculopathy (58.9%), while part of the cases with crescent formation (21.8%), capsular adhesion (11.1%) and pericapsular fibrosis (14.4%).(2) Of793patients, the distribution of immunofluorescence was A, AG, AM, and AGM in384(48.4%),128(16.1%),200(25.2%) and81(10.2%) patients respectively.The range of IgA fluorescence intensity was from+to++++and IgA++was the most common (48.4%). In addition,44.5%of the whole cases with complement deposition, of which C3depositon was the most common (95.7%).3. Relationship between clinical indicators and pathological features(1) According to Oxford Classification, the levels of mean arterial pressure (MAP) and UA were increased of mesangial cell proliferarion M1than MO (P<0.05, P<0.01, P<0.01, res.); Level of evaluated glomerular filtration rate (eGFR) was decreased of segmental sclerosis S1than SO and levels of24-UP, urinary red blood cell count (URBC), MAP and UA were elevated of S1than SO (P<0.01, res.); Between patients of endocapillary hypercellularity E0and El, only levels of URBC were different (P<0.01); In addition, levels of24-UP, URBC, MAP, UA and TG were increased along with the damage grade of tubular atrophy/interstitial fibrosis (TO, Tlamd T2)(TG:P<0.05; others： P<0.01)(2) Results showed that only URBC levels were different between different IgA fluorescence intensity (P<0.01) and had tendency to elevate along with the increase of IgA fluorescence intensity, while there were no difference between different IgA fluorescence intensity of other clinical indicators (P>0.05, respectively).(3) Of793IgA nephropathy cases, the whole clinical type mostly presented with FSGS. Among I-H, R-GH, U-ab, MP, HP and CRF FSGS accounted for72.4%、63.8%、58.7%、40.8%、67.7%and46.3%respectively. I-H easily presented with FSGS (P<0.05); The most common pathological type of MP was minimal lesion (ML) and membranoproliferative glomerulonephriti (MPGN); CRF easily presented with pathological type of proliferation segmental sclerosis glomerulonephritis (PSGN) and segmental sclerosis glomerulonephritis (SGN)(P<0.01, res.).The pathological type of ML, FSGS and mesangial cells proliferation glomerulonephritis (MsPGN) were mostly presented with U-ab and their ratio were41.3%(66),42.2%(192) and48.5%(48) respectively; The pathological type of PSGN and SGN were mainly presented with CRF and their ratio were61.5%(32) and85.7%(6); MPGN commonly presented with MP and accounted for70.0%(7).Conclusion(1) IgAN mainly occurred in young adults and frequently presented with hiding onset, thus should be diagnosed early.(2) IgAN had a variety of clinical manifestations, of which abnormal urindialysis was the most common.(3) IgAN presented with varied pathological changes and serious pathological lesions, of which FSGS and M0S1E0T0were the most common according to WHO pathologic definition and Oxford Classification respectively.(4) According to Oxford Classification, Levels of urinary findings, blood pressure, UA and eGFR evaluated at renal biopsy could reflect renal pathologic changes to some extend.(5) IgA fluorescence intensity was related with URBC, whose level evaluated at renal biopsy may reflect renal IgA deposition intensity.(6) Among793IgAN cases, there existed some relationship between pathological and clinical type. |
PDF Full Text Request