Clinical And Pathological Analysis Of 70 Patients With Primary IgA Nephropathy

Objective:To analyze the general situation,clinical manifestations and pathological features of primary IgA nephropathy,and to investigate the correlation between clinical manifestations and pathological changes,so as to provide theoretical and practical basis for the selection of treatment timing and program and its prognosis.Methods:From 2011 to 2016,70 patients diagnosed as IgA nephropathy in the Department of Nephrology,China Japan union hospital of Jilin University,were enrolled in the study.The patients with Henoch Schonlein purpura nephritis and other secondary renal damage were excluded.The clinical data and pathological data of 70 patients were retrospectively analyzed.According to Lee's classification,the pathological features of IgAN were analyzed,and the relationship between the clinical features and pathology was analyzed.Results:1.The age of onset ranged from 15 to 70 years old,with an average age of 33.54±11.62 years old and a peak age of 20~40 years old.There were 37 males and 33 females,with a male to female ratio of about(1.12:1).The male average age of onset was 33.72±11.80 years old,and the female average age of onset was about 33.35±11.60 years old.From the onset to the diagnosis of IgA nephropathy,the shortest course was 4days,and the longest was 180 months,with an average duration of440.73±274.43 days.2.The results of this study showed that in 7 clinical types of IgA nephropathy,the most common for asymptomatic abnormal urine type in23 cases(32.86%),followed by hypertension type in 18 cases(25.71%),massive proteinuria type in 17cases(24.29%),recurrent gross hematuria type in 8 cases(11.43%),simple microscopic hematuria type in 2 cases(2.86%),and end stage renal disease type in 1 case(1.43%).The average age of recurrent gross hematuria type was significantly different.(P <0.05)3.Among the 70 patients,the most common grade of Lee's pathology was grade III(n = 28)(40%),followed by grade IV(n=17)(24.29%)and grade II(n=12)(17.14%).Grade I(n=6)(8.57%)and V(n=7)(10.00%)were the smallest.The main form of immunoglobulin deposition was IgA+Ig M+C3,with a total of 29 cases,accounting for41.43%,followed by IgA+C3,with a total of 24 cases,accounting for34.29%.Immunoglobulin IgA deposition intensity "+++" had the most patients,with a total of 45 cases(64.29%),followed by "++",with a total of 20 cases(28.57%),"+" in 4 cases(5.71%)and "++++" in 1cases(1.43%).The kidney pathology of the patients with the type of asymptomatic urine abnormalities and the type of recurrent unaided eye hematuria were concentrated below the Lee's grade III.4.However,the kidney pathology of the patients with the type of massive proteinuria and the type of hypertension were concentrated mostly focuses on Lee's III and Lee's IV class,while there was no correlation between clinical classification and pathological grade.5.There were significant differences between the different Lee's pathological grades and the laboratory indexes,such as creatinine,urea nitrogen,serum immunoglobulin IgA and albumin(P < 0.05).For 63 IgA nephropathy patients with Lee's grade ? or below ?,their urea nitrogen,serum creatinine levels increased with the increased pathological grade,while the level of serum creatinine in patients with grade Lee V was lower than that in patients with grade Lee IV.The albumin was the highest in patients with Lee's pathology grade II,and the patient's albumin decreased with the increase of pathological grade.The serum immunoglobulin A was the highest in patients with Lee's grade IV and the lowest Lee in patients with pathology grade II.6.When IgA nephropathy occurs,the patients' glomerular filtration rate was usually not less than 60 ml / min / 1.73 m 2,and there was no significant difference between the pathological grades and the glomerular filtration rates(P> 0.05).Conclusion:1.For 70 cases of patients with IgA nephropathy and the age between 20 to 40 years old who were mainly young adults,male patients were slightly more than female patients.2.The asymptomatic abnormal urine type is the most common type for IgA nephrotic clinical classification,followed by high blood pressure type and massive proteinuria type.The clinical classification was of non-correlation with the degree of pathological changes.For patients with various clinical manifestations,the renal biopsy should be done even for the asymptomatic patients with abnormal urine to determine the pathology of the kidney.3.There was no correlation between the pathological grade of IgA nephropathy patients and the deposition forms and IgA deposition intensity of renal immunoglobulin.4.Although there was a correlation between different pathological grades and the tests of creatinine and urea nitrogen,there was no significant difference between different pathological grades and glomerular filtration rate.Therefore,the level of renal function can not be used as an indicator of the pathology severity.5.As the patients with different clinical classification can have massive proteinuria performance even though the patients' proportions in each classification are uneven,it is not appropriate to evaluate the severityof the disease with the level of serum albumin.