| Objective: To investigate the relationship between IgG deposition in mesangial area and the clinical manifestation,pathological changes and prognosis of IgA nephropathy(IgAN).Method: 102 cases of IgAN were selected from June 2009 to January 2017 in the nephrology department of Second Hospital Affiliated to Chongqing Medical University.According to the results of Ig G deposition in the mesangial area,the patients were divided into Ig G deposition group(43 cases)and non IgG deposition group(59 cases).The relationship between IgG deposition in mesangial area and general condition,clinical manifestation,pathological changes and prognosis of Ig AN patients were analyzed.In this study,the Oxford classification of IgA nephropathy was used as a pathological grading method for the selected patients.The endpoint includes doubling of baseline serum creatinine,halving of the eGFR or ESRD(maintenance hemodialysis,maintenance peritoneal dialysis,or renal transplantation).Kaplan Meier survival curve and Cox regression model were used to analyze the relationship between the IgG deposition in mesangial region and pathological indexes of the Oxford classification and renal prognosis.Result:(1)In this study,the rate of IgG deposition in mesangial are is about 42.3%.(2)The average age of the 102 selected patients was 37.5±12.8 years old,and male to female ratio was 1:1.43.There was no significant difference in age and sex ratio between the two groups(p>0.05).The mean time from onset of illness to renal biopsy in IgG deposition group was slightly longer than that in the non IgG deposition group,but the difference was not significant.(3)The most common reason for visit in the selected patients was edema,the second was physical abnormality and hypertension,and the thirdly was repeating gross hematuria.The proportion of doctoring due to hypertension in Ig G deposition group was significantly higher than the proportion in non IgG deposition group,and the difference was statistically significant(p<0.05).There was no significant difference in the rest of causes for doctoring in two groups.Compared with non IgG deposition group,the average blood pressure at admission,proteinuria,serum creatinine,blood uric acid and triglyceride were higher in IgG deposition group(P < 0.05),and eGFR is lower in IgG deposition group(p=0.015).There was no significant difference in hemoglobin,serum albumin,total cholesterol,serum IgG,serum IgM,serum IgA,C3 between the two groups(p>0.05).(4)Compared with the non Ig G deposition group,mesangial proliferation and endocapillary hypercellularity were more serious in IgG deposition group(p<0.05),and the intensity of IgA and C3 deposition in glomerular mesangial area is higher in IgG deposition group(p<0.05),but segmental sclerosis/cluster adhesion,tubular atrophy/ interstitial fibrosis,cellular/fibrocellular crescent and the deposition of IgM in the two groups had no obvious difference.(5)We followed up the rest of the 95 people who didn't reach ESRD.The mean follow-up time was 24.3 + 18.5 months,and there was no significant difference about follow-up time between the two groups.Kaplan Meier survival curve showed that the 5-year cumulative renal survival rates in the two groups respectively were: 54%,76%(log rank test X2 =1.109,p=0.292),but there was no significant difference about the renal cumulative survival rate between the two groups.And Kaplan Meier survival curve also showed tubular atrophy/interstitial fibrosis was relevant to the renal cumulative survival rate(p<0.001).In order to correct the interference of clinical indicators,we added urinary protein,systolic blood pressure and diastolic blood pressure and eGFR into COX regression model.Univariate analysis showed that eGFR and tubular atrophy/ interstitial fibrosis were associated with endpoint events;multivariate analysis showed that only tubular atrophy/ interstitial fibrosis was an independent predictor of poor prognosis of kidney.Conclusion: IgG deposition in mesangial area was related to more serious clinical manifestation and more obvious histopathological active lesions.The IgAN patients with IgG deposition in mesangial region showed a poor prognosis,but IgG deposition in mesangial region wasn't a renal prognostic factor independent of the pathological and clinical variables.tubular atrophy/ interstitial fibrosis in the Oxford classification was an independent risk factor for renal prognosis. |
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