| Research backgroundIgA nephropathy refers to the pathological manifestations of glomerular mesangial IgA deposition-based glomerulonephritis and the characteristics of the mesangial proliferation in the basic pathology.IgA nephropathy is the world's most common primary glomerular disease and the leading cause of End-stage renal disease in China.There was a wide range of clinical manifestations.The main symptoms were microscopic haematuria or the naked eye hematuria,and which can be associated with different levels of proteinuria,hypertension and impaired renal function.The study found that the degree of podocyte foot process effacement is in accordance with IgA nephropathy glomerular sclerosis and the aggravating GFR decline.The application of traditional Chinese medicine,effective ingredients of traditional Chinese medicine and compound treatment of Chinese herbal medicine in the treatment of IgA nephropathy with the intervention of podocyte has achieved certain results in clinical and animal experimental studies.However,the relevant studies on the characteristics of the TCM syndromes in the IgA nephropathy with podocyte injury syndrome have not been reported.Therefore,a retrospective single center study is to be used in this study to explore the clinical features,renal pathological features and the TCM syndromes differentiation in the patients of IgA nephropathy with podocyte foot process effacement(FPE).The study is expected to deepen the understanding of IgAN,and to provide the objective basis for TCM microdialectics.ObjectiveInitially explore the clinical features,renal pathological features and the TCM syndromes differentiation in the patients of IgA nephropathy with FPE.MethodlogyIn retrospective study,243 biopsy-proven cases were primary IgA nepropathy from January 1,2009 to December 31,2016 in Guang' an men Hospital Department of nephrology,China Academy of Traditional Chinese Medicine science.According to the degree of FPE observed under electron microscope,patients were divided into two groups,the group with FPE and the group without FPE.The clinical data of general situation,laboratory indicators,renal pathology and TCM four diagnosis were collected.Initially analysis the clinical features,renal pathological features,the TCM syndromes differentiation in the patients of IgA nephropathy with FPE.Results1 General situation1.1 IncorporationA total of 243 IgAN patients were enrolled in this study.There were 147 patients(60.49%)in the group without FPE and 96 patients(39.51%)in the group with FPE.1.2 GenderThe proportion of males accounted for 55.10%in the group without FPE and 51.00%in the group with FPE.There was no significant difference between the two groups(P>0.05).1.3 Renal biopsy of ageThe average age of renal biopsy were 38.13±11.05 years in the group without FPE and 36.89±12.85 years in the group with FPE.There was no significant difference between the two groups(P>0.05).The proportion of the ages between of 21 to 40 at renal biopsy were 60.5%in the group without FPE and 56.3%in the group with FPE.There was no significant difference between the two groups(P>0.05).1.4 Disease courseThe duration of the disease were 12.0(2.0,36.0)months in the group without FPE and 12.0(2.0,48.0)months in the group with FPE.There was no significant difference between the two groups(P>0.05).1.5 Body mass indexThe BMI were 24.80±3.32 kg/m2 months in the group without FPE and 24.89±4.04kg/m2 months in the group with FPE.There was no significant difference between the two groups(P>0.05).1.6 Predisposing factorsThe predisposing factors in the group without FPE were respiratory infection(18.4%),urinary tract infection(5.4%),pregnancy(3.4%),exertion(2.7%),gastrointestinal infection(1.4%).The predisposing factors in the group with FPE were respiratory infection(19.8%),urinary tract infection(4.2%),pregnancy(3.1%),exertion(2.1%),and gastrointestinal infection(1.0%).There was no significant difference between the two groups(P>0.05).2 Clinical indicators2.1 Starting clinical symptomIt was found that that starting clinical symptom were fatigue(18.4%),edema(17.0%),the naked eye hematuria(14.3%),lumbar discomfort(10.9%),hypertension(6.8%),bubble urine(4.8%),other(3.7%)in the group without FPE.It was found that that starting clinical symptom were edema(38.5%),to the naked eye hematuria(11.5%),fatigue(8.3%),lumbar discomfort(7.3%),hypertension(6.3%),bubble urine(5.2%),other(3.1%)in the group with FPE.There was no statistically significant difference between the two groups(P>0.05).2.2 Hypertension classificationThe proportion of patients with hypertension was 59.1%in the group without FPE and71.9%in the group with FPE.There was no statistically significant difference compared between two groups(P>0.05).2.3 24-hour urine protein quantitationThe median 24h-UTP was 1.04 g/24h in the group without FPE,and 2.34 g/24h in the group with FPE.There was a statistically significant difference between the two groups(P<0.01).The rate of patients with 24h-UTP between 1 and 3.5 g/24h was 45.6%,and 5.4%of patients with 24h-UTP>3.5g/24h in the group without FPE.The rate of patients with 24h-UTP between 1 and 3.5 g/24h was 61.5%,and 28.1%of patients with 24h-UTP?3.5g/24h in the group with FPE.There was significant difference between the two groups(P<0.01).2.4 Serum AlbuminThe median ALB value was 39.25g/L in the group without FPE and 35.95g/L in the group with FPE.The difference between the two groups was statistically significant(P<0.01).2.5 Renal function and stage of chronic kidney diseaseIn the group without FPE,Scr was 84.0(67.3,108.8)umol/l,BUN was 5.30(4.32,6.88)mmol/1,UA was 373.74±104.84 umol/1,and eGFR 89.0(66.5,110.0)ml/Minl.73m2.In the group with FPE,Scr was 99.5(77.8,141.8)umol/l,BUN was 6.51(4.99,8.41)mmol/l,UA was 413.72±1106.45 umol/l,and eGFR 74.0(51.0,104.0)ml/min1.73m2.The differences in BUN,SCr,UA,and eGFR between the two groups were statistically significant(P<0.01).The proportion of CKD1-5 stage in the group without FPE was respectively 53.7%,27.9%,17.7%,0.7%,and 0%;the proportion of CKD1-5 in the group without FPE was respectively 39.6%,26.0%,20.8%,9.4%,and 4.2%;the statistical difference between the two groups was significant(P<0.01).2.6 Blood lipid profileIn the group without FPE,the CHO was 4.82(4.24,5.46)mmol/l,the TG was 1.70(1.21,2.57)mmol/1,the HDL-C was 1.17(0.98,1.38)mmol/l,and the LDL-C was 2.93(2.46,3.35)mmol/1.In the group with FPE,CHO was 5.40(4.27,6.59)mmol/l,TG was 1.81(1.28,2.52)mmol/l,and HDL-C was 1.22(1.00,1.44)mmol/l,LDL-C was 3.36(2.60,4.03)mmol/1.There was a statistically significant difference between the two groups in CHO and LDL-C(P<0.01);there was no significant difference between the two groups in TG and HDL-C(P>0.05).2.7 Urine red blood cell count at high magnificationThe average RBC-M of the group without FPE was 9.60±2.89/HP,and the average RBC-M of the group with FPE was 9.54±3.26/HP,there was no statistically significant difference between two groups(P>0.05).3 Renal pathology3.1 Renal pathology typeBoth groups were the most common renal pathological types(65.3%vs65.6%).There was no significant difference between the two groups in the histopathological group,which showed that there was a 6.3%appearance of crescent in the group with FPE.There was no statistically significant difference compared between two groups(P>0.05).3.2 Oxford pathology classificationThe incidence rates of the Oxford typing M1,El,S1,T1+2 and C1+2 were respectively 91.8%,12.2%,41.5%,53.1%,and 51%in the group without FPE.The incidence rates of the Oxford typing Ml,El,S1,T1+2 and C1+2 were respectively 95.8%,25.0%,49.0%,71.9%and 63.5%in the group with FPE.There was no significant difference between the two groups in M and S(P>0.05).E and C were statistically significant(P<0.05);T was statistically significant(P<0.01).3.3 Immunofluorescence depositionsThe three most common types of immune complex were IgA+IgM+C3(40.4%),IgA+C3(35.6%)and IgA(10.3%)in the group without FPE.The three most common types of immune complex in the group with FPE were IgA+IgM+C3(41.9%),IgA+C3(25.8%),IgA+IgM+IgG+C3(12.9%).There was no statistically significant difference compared between two groups(P>0.05).4 TCM syndrome differentiation4.1 TCM symptom frequency distribution.The 10 most common symptoms of TCM are lack of strength,soft waist and knee,facial swelling,extremities edema,sweating and sweating,five nerves,yellow complexion,easy cold,sore throat and dizziness.4.2 TCM master certificateThe most common three main syndromes in the group without FPE were Qi and Yin deficiency syndrome(38.1%),liver and kidney Yin deficiency syndrome(23.1%),lung and spleen deficiency syndrome(20.4%).The other group was the qi Yin deficiency syndrome(39.6%),lung spleen deficiency syndrome(29.2%),liver and kidney Yin deficiency syndrome(19.8%).There was no statistically significant difference between the two groups(P>0.05).4.3 TCM sthenia syndromes64 patients did not incorporate any TCM sthenia syndromes.The most common evidence of both groups was blood stasis.The proportion of dampness syndrome in the group without FPE was significantly lower than that in the group with FPE(8.2%vs 16.7%),and higher in the dampness and heat syndrome than in the group without FPE(23.1%vs 13.5%).The composition ratio is not significantly different.There was no significant difference between the two groups(P>0.05).Conclusions1 The laboratory indicators showed higher proteinuria,worse renal function,higher levels of CHO and LDL-C in IgA nephropathy with FPE.2 The incidence of the Oxford classification E,T,and C was higher in IgA nephropathy with FPE.It is suggested that the degree ofFPEmay be one of prognostic factors for the poor prognosis of IgA nephropathy.3 Qi and Yin deficiency was the most syndrome,and Blood stasis syndrome was the main sthenia syndroms in IgA nephropathy with FPE. |
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