Study On The Correlation Between The Serum Bilirubin Level And The Clinicopathologic Features Of Ig A Nephropathy

Objective: To explore the relationship between serum bilirubin level and the clinical and pathological features and detect some proofs for the treatment for patients with IgA nephropathy.Methods: A single center,cross-sectional,observational study was designed.The patients diagnosed with IgA nephropathy were enrolled during the Aug.2008 to Dec.2015 in General Hospital of Ningxia Medical University.The data including demographic informations,laboratory items and pathological results were collected.Then,the relationship between the serum bilirubin levels and the laboratory indexes and the pathological data was analyzed.Results: A total of 612 patients with primary IgA nephropathy diagnosed by renal biopsy were enrolled in this study.There were 326(51.5%)male patients and 286 female cases.(1)Patients were grouped by the the serum bilirubin levels through interquartile method.When the serum TBIL levels gradually increased,the levels of serum UA,TP,ALB and HB were increased accordingly,while the serum GLU and 24 hour urine protein contents were decreased accordingly.The proliferation of glomerular mesangial cells,tubular atrophy /interstitial fibrosis were reduced gradually with the serum TBIL.(p < 0.05).(2)The patients were grouped into ?1g group and < 1g group according to the 24 hour urinary protein quantitative data.The patients in ?1g group had higher levels of DBP?SBP?MAP?Scr?TG,lower levels of TP?ALB?TBIL?eGFR,and more serious pathological damage degree when compared with the patients in <1g group(p < 0.05).(3)The patients weregrouped by eGFR with 45 ml/min/1.73m2 cutoff.The patients with eGFR ? 45ml/min/1.73m2 group were younger,with lower levels of DBP,SBP,MAP,Scr,UA,24 hour urinary protein quantitative data,and HB,lower incidence of hypertension,higher levels of TBIL,TP,ALB,and less serious pathological damage degree,when compared with the patients with eGFR<45 ml/min/1.73m2 group(p < 0.05).(4)The patients were grouped into nephrotic syndrome(NS)group and N-NS group.The patients in the NS group had a higher levels of DBP?SBP?MAP?Scr?CHOL,lower levels of TBIL?HB?eGFR,more serious proliferation of mesangial cells,renal tubular atrophy and interstitial fibrosis degree when compared with the patients in the N-NS group(p < 0.05).(5)The patients were grouped according to the proliferation degree of mesangial cells.The patients in M1 group had higher SBP,MAP,Scr,Glu,urinary protein quantitation and incidence of hematuria,lower levels of TP,TBIL,HB,and eGFR than the patients in M0 group(p < 0.05).(6)The patients were grouped according to the degree of the renal tubular atrophy and interstitial fibrosis.With the aggravation of pathological damage degree,the levels of DBP,SBP,MAP,Scr,UA,urine protein quantitation and the incidence of hypertension were increased gradually,while the levels of TP,ALB,HB,and eGFR were decreased gradually.The bilirubin levels in the patients in T0 group were higher than that in T1 and T2 group(p <0.05).(7)The logistic regression analysis suggested that the SBP?MAP?Scr?GLU,and urinary protein levels were risk factors of proliferation of glomerular mesangial cells,while the TBIL?HB and eGFR were protective factors.The DBP,SBP,MAP,Scr,UA and urinary protein levels were risk factors of renal tubular atrophy and interstitial fibrosis,while the TP,ALB,TBIL,HB and eGFR were protective factors(p < 0.05).Conclusions: The serum bilirubin level may be related with the development of IgA nephropathy.The pathological degree of the IgA nephropathy patients with higher serum bilirubin levels may be milder.