| ObjectiveTo analyse the relationship between the clinical characteristics and pathological classification of Ig A nephropathy in the first hospital affiliated to Soochow university and provide evidences for clinical prognosis and treatment.MethodsTo analyse the clinical characteristics and pathological datas of 117 Ig AN patients from our hospital in recent 3 years which were diagnosed by renal biopsy. All excluded patients with systemic lupus erythematosus(SLE), allergic purpura, hepatitis b viral hepatitis, psoriasis, sjogren’s syndrome caused by secondary Ig A nephropathy, We collected information include its basic statistics(age, gender, preceding infection), clinical manifestation(with macroscopic haematuria, asymptomatic microscopic hematuria with or without associated with proteinuria, edema(not a large amount of proteinuria) with abnormal urine test and/or high blood pressure, nephrotic syndrome, chronic renal failure), laboratory results(24 h urine protein quantitative, biochemical index) and pathologic results(Hass), according to the pathological classification which is divided into 5 types. To observe the relationship between pathologic results(Hass) and each model with high blood pressure, serum levels of C3, pathological Katafuchi score.Resuls1.354 cases of renal biopsy in patients with the primary lg A nepropathy in 117 cases, the detection rate was 33.1%.Patients with an average age was(32.12 + 9.50) years old. The 20 to 29 year old group was predominant, which rate was 42.7%(50/117).2. There were 14 patients(12%)of all Ig AN people with precursor infection,including 12 cases of upper respiratory tract infection and 2 cases of urinary tract infection. There were 15 patients with macroscopic haematuria, which rate was 12.8%, the average age of less with macroscopic hematuria patients have significant difference(P < 0.01).3. The clinical manifestations of Ig A nephropathy patients were diverse. The data show that the asymptomatic abnormal urine test(microscopic haematuria with or without albuminuria) patients was the most common for 51 cases(43.6%);Followed by a lot of proteinuria(non) with abnormal urine test edema and/or high blood pressure, for 29 cases(24.8%).The heavy proteinuria of nephrotic syndrome was 19(16.2%);There was 15 patients(12.8%) with macroscopic hematuria; Renal failure characterized by CKD4 phase was 3 cases(2.6%).4.In 117 patients with Ig A nephropathy,there were 70 cases of CKD1 period accounting for 59.8%;CKD2 period of 35 cases, accounting for 29.9%;CKD3 period for 9 cases, accounting for 7.7%;CKD4 period for 3 cases, accounting for 2.6%, no CKD5 period patients.5. Pathologically, there was a variety of pathological types of primary glomerular disease. With slight pathological changes(Hass I type) is the most common, accounting for 40.1%(47/117).Immune pathological Ig A deposits to + + + is the most common intensity, about 43.6%, + + times, accounting for about 33.3%, + + + + again, accounting for 23.1%.Pure Ig A was 59.8%(70/117);Ig A and Ig G deposition 12 cases(10.3%);Ig A+ Ig M sedimentary 9 cases(7.7%);Ig A + Ig M + Ig G deposition in 3 cases(2.6%);C3 deposition is the most rare, accounting for 94.9%(111/117);With C4 deposition was 10 cases(8.5%), those with C1 q deposition was 12 cases(10.3%).6. The age and serum creatinine level of Ig A nephropathy patients with hypertension were significant statistical higher than those without hypertension group(P < 0.01); Ig A nephropathy patients with hypertension group between pathological index balls, hardening index, quality index, the index was higher than those without hypertension group(P < 0.05).7. The pathological classification of Hass Ⅴ mean arterial pressure level was higher than Hass I, Ⅱ, Ⅲ grade(P < 0.05); Glomerular filtration rate(e GFR) in patients with Hass I level was statistically higher than Hass Ⅱ level(P < 0.05); Glomerular filtration rate(e GFR) of HassⅤlevel was less than Hass I,Ⅱ,Ⅲlevel(P < 0.05).8. Group B(Hass III- V) of Ig AN patients compared with group A(Hass I- grade II), serum levels of C3 was significantly lower(p < 0.01) and increased Katafuchi score was significantly increased(p < 0.01).Pathological C3 sedimentary strength for "+ + +" to "-", serum levels of C3 was lower, statistically significant(P < 0.05);Strength of C3 deposit "+ +", "+ + +" patients, respectively, compared with patients with C3 deposit for the "+", serum C3 level was lower, all statistically significant(P < 0.05).Conclusions1. The incidence of Ig A nephropathy was 33.1% of renal biopsy. Most people were at young and middle-aged. There were 12% of patients with preceding infection and 12.8% of patients with macroscopic hematuria. Ig A nephropathy patients presented with macroscopic hematuria was younger than those without macroscopic hematuria.2. The clinical manifestation and pathological type were various. The most common clinical manifestations of Ig AN was asymptomatic abnormal urine test(microscopic haematuria with or without albuminuria).The most common pathological types was Hass I(minor lesions)type. Immune pathological Ig A deposits to + + + was the most common intensity. Only slightly in the clinical and pathological mild can predict the good prognosis.3. Serum C3 level of the Ig A nephropathy patients may be as one of indexes of judging disease progression.4. Ig A nephropathy with persistent hypertension, higher pathological Katafuchi score, and interstitial fibrosis were associated with poor outcome. |
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