The Clinical And Pathological Characteristics Of Children With IgA Nephropathy

Objective The study analyzed the clinical manifestations and renal pathological characteristics of children with IgA Nephropathy(IgAN)and explored the relationship between clinical manifestations and renal pathology in children with IgA Nephropathy.Methods The analysis was performed retrospectively in children with IgAN admitted to The Children's Hospital Affiliated to Soochow University from Jan.2011 to Dec.2017,including clinical manifestations,laboratory examination and renal pathology.SPSS 19.0 was used to perform statistics.Results (1)General information:72 cases of IgA nephropathy in children,47 males and 25 females,male to female ratio of 1.88: 1.The age of onset was from 4 to 17 years old,with an average age of 10.4 years and 2.6 years and a peak onset age of 7 to 13 years old.There were 48 cases(66.7%)with tonsil enlargement and 33 cases(45.8% The above enlargement.The main reasons for the diagnosis were gross hematuria and abnormal urinalysis.The number of cases and their proportions were 39 cases(54.17%)and 27 cases(37.5%).(2)The clinical classification of 72 cases of IgA nephropathy: isolated microscopic hematuria accounted for 3 cases(4.2%);the highest incidence of gross hematuria accounted for 33 cases(45.8%);isolated proteinuria 1 case(1.4%),12 cases(16.7%)with hematuria and proteinuria,8 cases(11.1%)with acute nephritis and 15 cases(20.8%)with nephrotic syndrome.(3)Serum biochemical tests in 72 children with IgA nephropathy showed that the number of cases with blood hypercholesterolemia,elevated serum triglycerides and serum albumin decreased in the following order: 17 cases(30.6%),22 cases(30.6%)and 22 cases(30.6%).The results of hematological immunology in 72 children with Ig A nephropathy showed that IgA increased in 67 cases(93.1%),the level of complement was basically normal.Urinalysis results showed hematuria and proteinuria in most patients,the number of cases and the proportion of 68 cases(94.5%)and 39 cases(54.2%).(4)According to the grade of IgA nephropathy,25 cases(34.7%)were M0E0S0T0,11 cases(15.3%)M1E0S0T0,11 cases(15.3%)M0E0S1T0 and 7 cases(9.7%)M1E0S1T0.Among the 72 children,28(38.9%)were Ml,10(13.9%)were El,30(41.3%)were S1,11(15.3%)were T1,and T2 was 0 Of the 22 patients(30.5%),two or more lesions occurred.72 cases of IgA nephropathy renal biopsy showed mesangial proliferation,with mild and moderate mesangial hyperplasia,followed by 30 cases of glomerular segmental sclerosis(41.7%),capillary endothelial cell hyperplasia in 10 cases(13.9%),renal tubular atrophy / interstitial fibrosis in 11 cases(15.3%).Glomeruli associated with crescent formation in 11 cases(15.3%),glomerular balloon adhesion in 10 cases(13.9%),interstitial inflammatory cell infiltration in 32 cases(44.4%).(5)Immunofluorescence was mainly IgA deposition.The number of cases was 45 cases(62.5%)and IgA fluorescence intensity was 2+.There were 39 cases(51.2%)of them were immunofluorescence.There was no C1 q deposition in 72 cases,With complement C3 deposition in 43 cases(59.7%).(6)Laboratory tests and Oxford pathological classification: mesangial proliferative lesions M1 and M0 24 hours-urinary protein(24h-UP),serum creatinine(Scr),cystatin C(Cys C),glycerol Serum triglyceride(TG)and cholesterol(CHOL)levels were significantly increased(P <0.05),albumin(ALB)levels were significantly lower(P < <0.05).The levels of Scr,BUN and UA in tubular atrophy / interstitial fibrosis were significantly higher than those in T0(P <0.05).(7)Results showed that only URBC levels were different between different IgA fluorescence intensity(P<0.05)and had tendency to elevate along with the increase of IgA fluorescence intensity.(8)The Oxford pathological classification is further divided into M0E0S0T0 and non-M0E0S0T0,found that hematuria and proteinuria,nephrotic syndrome,non-M0E0S0T0 accounted for the vast majority,respectively,83.3% and 93.5%.Conclusions:(1)IgA nephropathy in children occurs predominantly in school-age children(7 to 13 years of age),and the proportion of tonsillar enlargement in children of this age is high,suggesting that tonsillitis is associated with the pathogenesis of IgA nephropathy.(2)IgAN presented with varied pathological changes and serious pathological lesions,of which M0S0E0T0,M1S0E0T0,M0E0S1T0 were more common according to Oxford classfication.There is a link between clinical classification and pathological type,but not parallet,emphasizing the importance of renal biopsy.(3)URBC level in IgA nephropathy renal biopsy can reflect the renal IgA deposition intensity.