Comparative Analysis Of HSPN And IgAN About The Clinical And Pathological Characteristics,therapy And Prognosis In Adults

Objective:To compare the clinical and pathological findings,therapy and prognosis of Henoch-Schonlein purpura nepbritis(HSPN)and IgA nephropathy(IgAN)in adults.Methods:One hundred and sixty patients with HSPN and 334 patients with IgAN were enrolled in this study.They were all CKD?/?/? stage adults who were renal biopsy-proven HSPN or IgAN in the First Affiliated Hospital of Zhejiang University School of Medicine from 1st Jan 2004 to 31th December 2013 with at least three years follow-up.They were devided into group HSPN and group IgAN.We collected and analysised their baseline data of demographics,clinical and renal pathological characteristics,laboratory results,as well as the follow-up information of their immunosuppressive therapy and the rate of end events.The patients with endocapillary hypercellularity and the patients at CKDII/III stage in the two groups were compared and analysis separately.Results:1.There was no significant difference about age,gender,clinical manifestations,urine red blood cells,24 hours urinary protein,serum albumin,serum globulin,hemoglobin,the rate of nephrotic syndrome between the group HSPN and the group IgAN(P>0.05);More patients with hypertension in the group IgAN than the group HSPN(P<0.05).Worse renal functionwhich included higher serum creatinine and lower glomerular filtration rate(eGFR)was observed in IgAN than the group HSPN(P<0.05).The rate of loops necrosis was no obvious difference between the two groups(P>0.05),while the crescents ratio(including cellular crescents and segmental crescents),the rate of endocapillary hypercellularity in the HSPN were higher than those in the IgAN(P<0.05).At the same time,more glomerular sclerosis(including global sclerosis and segmental sclerosis),more renal tubular atrophy,more inflammatory cell and fibroblasts in renal interstitium was seem in the IgAN than HSPN(P<0.05).Both IgAN and HSPN showed IgA immune complexes despositing on the mesangial area,mostly with C3 deposits,also there was no significant difference about the type,intensity and position of the immune complex deposition(P>0.05);The patients with IgAN used more ACEI/ARB drugs but less immune inhibitors than the patients with HSPN(P<0.05).After more than 3 years follow-up,there was 11.7%patients achieved end event in the group IgAN,while only 5.7%patients in the group HSPN(P<0.05).2.When we compared the data of the patients with endocapillary hypercellularity,there were 51 patients in the group IgAN and 46 patients in the group HSPN.No significant difference was found in the two groups about their age,gender,urine red blood cells,24 hours urinary protein,serum albumin in the group HSPN and the group IgAN(P>0.05).The group IgAN still had more serious renal damage with higher serum creatinine,lower glomerular filtration rate(eGFR),more glomerular sclerosis and more more renal tubular atrophy than the group HSPN(P<0.05).Both about 70%patients of the two groups used immunosuppressive therapy and their rates of end events were similar(P<0.05).3.When we compared the data of the patients at CKDII/III stage,there were 174 patients in the group IgAN and 43 patients in the group HSPN.We found that the patients were elder,and had more red blood cells in urine,lower serum albumin with HSPN than them with IgAN(P<0.05).The renal function of the two groups was no statistical difference(P>0.05).In the renal pathology,the group HSPN showed more crescents and endocapillary hypercellularity,while the group IgAN showed more glomerular sclerosis and renal tubular atrophy(P<0.05).About 62%patients of the two groups used immunosuppressive therapy,finally,the renal prognosis of the group HSPN is better than the group IgAN(P<0.05).Conclusion:The clinical manifestations of HSPN and IgAN were similar in adults,while it was apparently different in the renal pathological manifestations,immunosuppressive therapy and prognosis between the two diseases.The HSPN prognosis was better than IgAN.Nevertheless,strengthening the immune inhibitor treatment in the patients with IgAN and whose renal biopsy showed endocapillary hypercellularity was significative to improve the progonosis.There still was obvious hematuria,proteinuria and active lesions of renal biopsy in the elder HSPN patients with poor renal function,and better prognosis was observed after immunosuppressive therapy than IgAN.