Analysis Of Clinical And Pathological Characteristics Of IgA Nephropathy Of 1011 Patients

PurposeIgA nephropathy is a common kidney disease,its prognosis and clinical manifestations are different.The incidence of IgAN in different regions is significantly different.And in recent years,with the social and environmental factors change,the incidence of IgAN has been significantly changed.The analysis of the epidemiological characteristics of IgAN in Tianjin is helpful to prevent IgAN and ESRD and improve the prognosis of patients with CKD.The clinical and pathological data of these patients were analyzed to explore the epidemiological characteristics of IgAN in Tianjin and surrounding areas and the changes in the past 10 years,The analysis of the relationship between clinical manifestations and renal pathology explore evidence of diagnosis and treatment of IgAN.MethodClinical and pathological data of patients diagnosed as IgAN after primary renal biopsy at the Tianjin Medical University General Hospital from January 2007 to December 2016 were collected,including:(1)clinical data : sex,age,gross hematuria,blood pressure levels,hemoglobin,serum creatinine,eGFR,blood uric acid,urine protein,hematuria,serum C3,C4,IgA,etc.(2)Pathological changes: mesangial proliferation,endocapillary proliferation,segmental sclerosis or adhesions,renal tubular atrophy or fibrosis,crescent,renal artery lesion.clinical typing and pathologic typing(Oxford pathology,Hass grade).Analyze the epidemiological characteristics,the relationship between clinical manifestations and renal pathology.Result1.Incidence and demographic data: primary IgAN accounted for 25.8% of the total number of renal puncture in the same period(1036/4017).From 2007 to 2016,the detection of IgA nephropathy is decrease.The median duration of the disease was 3 months(3 days to 30 years),the average age is 36.4 ± 12.5 years(6 to 75 years),and male to female ratio is 1: 1.09.There is no difference of age in gender(P> 0.05).2.Purpose for treatment: Urine abnormalities 44.4%,edema 20.3%,infection 15.5%,gross hematuria 13.3%,back pain 2.8% and hypertention 2.7%.3.Hematuria and proteinuria: gross hematuria 25.3%(233/922),16.2%(101/623)patient's urine protein is more than 3.5g / 24h;7%(43/618)patients have proteinuria only,7.6%(47/618)patients have hematuria only.4.hypertention,anemia and Renal insufficiency :The MAP was 97.9 ± 13.6 mmHg,the patients with hypertension accounted for 41.2%;16.3% patients with anemia(mainly mild anemia),60% patients with normal renal function,19.8% patients with mild renal dysfunction,and 1.4% ESRD.5.Clinical classification: IH type 2.7%,U-ab type 33.9%,R-GH type 21.5%,Cres type 7.8%,MP type 9.1%,HT type 23.5%,ESRD type 1.5%.6.Pathological type: Hass I 19.9%,Hass II 14.3%,Hass III 43%,Hass IV 13.3%,Hass V 9.5%;the top six of the Oxford pathology are,M0E0S0T0 43.4%,M0E0S1T0 16.2%,M0E0S1T1 7.4%,M0E1S0T0 7.2%,M0E0S0T1 5.2%,M0E0S1T2 4.7%.7.with other pathologic changes: 11.2% with ischemic renal injury,3.4% with renal interstitial / tubal injury,0.9% with obesity-associated glomerular hypertrophy,0.9% with diabetic nephropathy sclerosis,3% with membranous nephropathy.8.Clinical manifestations and Hass classification: IH type mainly Hass I;U-ab type,R-GH type,Cres type,MP type,HT type mainly Hass III.ESRD type mainly Hass V.With the increase of Hass grade,the mean values of MAP,Scr,UA and 24 h Upro increased,while the mean values of Hb and urinary RBC decreased.9.MAP is related to E,S,T,C;Hb is related to M,T,C;Scr is related to S,T,C;UA is related to S,T,C;Upro is related to E,S,T,C.Conclusion 1.From 2007 to 2016,the detection of IgA nephropathy is decrease.The main purpose for treatment is urine abnormalities.2.The main clinical classification is U-ab type.Hass? and M0E0S0T0 are the most common clinical manifestations.3.There is a certain relationship between clinical manifestations and pathologic changes.