Correlation Between Angiopathy Of IgA Nephropathy And Blood Stasis Syndrome

IgA Nephropathy is a worldwide highly incidence of primary glomerular disease,which is more common among Asians,especially Japanese and Chinese.It is characterized by IgA deposition in the mesangial region,and diagnosed by renal biopsy.Traditional Chinese medicine(TCM)thinks that its core pathogenesis is asthenia in origin and asthenia in superficiality in which blood stasis syndrome is most common.It runs through the disease and is closely related to the condition and progression of disease.It is closely related to the progress and prognosis of the disease.Compared with other primary glomerular diseases,the vascular lesion and ischemic sclerosis of glomeruli are more common in IgA nephropathy.Ischemic sclerosis of glomeruli may caused by vascular lesion.Some scholars believe that some pathological lesions of the kidney,such as the ischemic crinkle of the capillary loop,can be seen as blood stasis syndrome in the kidney.Based on clinical experience,we observed the relationship between blood stasis syndrome and clinical physical and chemical indexes,pathological changes,especially vascular lesions and ischemic kidney injury in IgA nephropathy.1 PurposeBy using retrospective and cross-sectional method,combined with blood stasis syndrome,we aimed to discover the association between lesion of renal arteriole,ischemic sclerosis of glomeruli and blood stasis in IgAN,and clear the relationship between the blood stasis syndrome with the proportion of glomerular ischemic sclerosis,renal pathological scores(especially vascular diseases score)and the physical and chemical indicators which can provide theoretical basis for the use of herbs promoting blood circulation for removing blood stasis in clinical treatment.Counting the frequent of symptoms of blood stasis syndrome in the practical guide to the diagnosis of IgA nephropathy and TCM syndrome differentiation formulated by kidney disease professional committee of China Chinese and western medicine academy("2013 practice guide")among IgAN patients with blood stasis syndrome,which is the basis of the establishment of the standard of renal blood stasis syndrome.2 MethodsSelect patients who underwent renal biopsy and were diagnosed with primary IgA nephropathy from January 2013 to February 2018 at the Guang'anmen hospital and were diagnosed with IgA nephropathy including.For patients from January 2013 to December 2016,use retrospective analysis method and collect clinical datas,including laboratory indicators,Oxford pathological and vascular integral ischemic sclerosis ratio and so on.For patients January 2017 to February 2018,use the method of cross-sectional analysis and collect clinical datas,including laboratory indicators,blood stasis syndrome integral(judged by "practical diagnosis standard of blood stasis syndrome of Chen"),Oxford pathological and vascular integral,ischemic sclerosis ratio and so on.Group the subjects according to with or without glomerular ischemic sclerosis;Group the subjects according to vascular integral(three groups:Ogroup 1 group 2group).Exclipit the difference between groups and the relevance within group of above clinical datas.3 Results3.1 In 204 cases of primary IgAN,58.33%patients have glomerular ischemic sclerosis,and ischemic sclerosis ratio in the glomerular ischemic sclerotic group is 15.755%(2.8%,83.3%).And 88.3%patients have vascular lesions.3.2 There is significant difference in age,BMI,BUN,TG,and eGFR between patients with or without glomerular ischemic sclerosis.And higher level of age(40(32,49)/34(27.5,45),P=0.015),BMI(25.2208±4.09368/23,8759±3.67919,P=0.014),BUN(6.5(5,8.2)/5.70(4.35,7.40),P=0.012),TG(1.88(1.265,2.76)/1.55(1.095,2.435),P=0.047)and lower lever of eGFR(69.9605±31.04141/79.9972±33.93585,P=0.017)in patients with glomerular ischemic sclerosis.3.3 Vascular lesions and the classification of hypertension(judged by the previous hightest blood pressure lever)both have positive correlation with the proportion of glomerular ischemic sclerosis ratio(P<0.01),and are not related to systolic blood pressure and diastolic blood pressure(judegd by blood pressure when renal biopsy).3.4 Of the 46 patients judged by the practical standard for the diagnosis of blood stasis syndrome of Chen,compared with patients without glomerular ischemic sclerosis,patients with glomerular ischemic sclerosis have higher blood stasis syndrome integral(4(3.25,5)/2.5(0,4.25),P=0.003).3.5 There is a positive correlation between the proportion of glomerular ischemic sclerosis ratio,renal tubular atrophy or interstitial fibrosis(T)and vascular integration(P<0.01).3.6 Sex is not related to the glomerular ischemic sclerosis and vascular lesions.3.7 There is a positive correlation between patients within the three groups(grouping by vascular integral:groupO group 1 group2).With the severer of vascular lesions the lever of Scr is higher(groupO vs groupl vs group2 76.5(55,103.25)/93(72.5,132.5)/147(117,169),P=0.000).3.8 There is significant difference between groupO and groupl,between groupO and group2 patients with vascular lesion,no difference between groupl and group2 in TG lever.Compared with patients without vascular lesion,patients with vascular lesions have higher TG lever.3.9 Compared with patients without vascular lesions,renal tubular atrophy or interstitial fibrosis(T)is more common in patients with vascular lesions(groupO vs groupl P=0.000,groupO vs group2 P=0.000,groupl vs group2 P=0.143).3.10 In 46 patients the four highest frequency symptoms of blood stasis syndrome in "the 2013 practice guidelines" were:pale dull tongue(24 times),low back pain(18 times),dark color menses(10 times),and multiple blood clots menstruation(10 times).According to the"practical diagnosis standard of blood stasis syndrome of Chen",blood stasis syndrome score points 2-6 in patients with blood stasis syndrome in this study.3.11 After getting rid of the menstrual factors,according to the practical standard for the diagnosis of blood stasis syndrome of Chen,blood stasis score is not different between men and women;and considering the menstrual factors,women have higher level of blood stasis score(P=0.020).4 ConclusionGlomerular ischemic sclerosis and vascular lesions are common in primary IgA nephropathy,which may reflect chronic lesions to a certain extent;Glomerular ischemic sclerosis plays a role in the diagnosis of blood stasis syndrome in renal disease which can be considered as an item when establishing the diagnostic criteria for blood stasis syndrome in renal disease.