| Background and objective:IgA nephropathy is the leading cause of chronic kidney disease and end-stage renal disease and has developed into the most common primary glomerular disease in the world.Because of the diversity of clinical symptoms and pathological features in patients with IgA nephropathy,it is necessary to systematically study the relationship between the two.The Oxford classification of IgA nephropathy released in 2009 has attracted the attention of researchers and medical staff.The use of this type of method can effectively improve the reproducibility of pathological indicators and enhance the predictive value of renal prognosis.IgA nephropathy belongs to the category of immunopathology diagnosis.At present,there are few studies on the pathological changes of lgA nephropathy by light microscopy and immunofluorescence.Therefore,this paper intends to study the correlation between clinical and pathological features of lgA nephropathy and the correlation between clinical and light microscopy and immunofluorescence pathology.Methods:The first renal biopsy report was collected from the unit for nearly 10years(from January 2008 to October 2018),and a total of 222 cases were identified for the diagnosis of primary IgA nephropathy in children.The characteristics and correlations of the information in these cases(including:general information,clinical data,Haas classification,Oxford classification,immunofluorescence,intrarenal artery disease,crescent)were analyzed.Results:(1)The average age at the time of renal biopsy was 9.1±3.0 years;the most common time was>9 years old and?12 years old,accounting for 35.1%;the ratio of male to female was 2.64:1;83.8%of the children underwent renal biopsy within 6 months of onset;73.9%of children had episodes of gross hematuria before renal biopsy;the clinical manifestations were nephritic nephrotic syndrome,the most common,accounting for 37.8%;19.82%of the children had hypertension when admitted to hospital.(2)The average 24-hour urine protein quantitation was(1.45+1.63)g/d during renal biopsy;the proportions of mild,moderate,and severe proteinuria were 28.83%,17.57%,and 39.19%,respectively;glomerular filtration was estimated.The average rate of eGFR was 155.19±34.15ml/min.1.73m~2.94.59%of the children were in CKD-? stage;most of the children had albumin level?30g/L,accounting for 74.3%;27.5%of children showed high cholesterol Hypertension;19.8%of children showed hyperuricemia.(3)Pathological features:Lee's grade is the most common grade ?,accounting for 49.1%(109 cases),Lee's grade V is the least,accounting for 0.9%(2 cases);Haas'grade is the most grade ?,accounting for 42.3%(94 cases),Haas's V-class ratio is the lowest,accounting for 0.5%(1 case);Oxford classification index M1,E1,S1,T1 lesions accounted for 26.57%,59.5%,26.1%,9.5%,respectively,no T2 lesions;48.2%of children with crescent shape,crescentic lesions glomerular kidney The total number of balls<5%was 27 cases,5-10%was38 cases,10-25%was 41 cases,25-50%was 11 cases,and only 2 cases(0.9%)had crescent lesions of glomeruli.The proportion is more than half of the total number of glomeruli;the incidence of glomerular global sclerosis accounts for 25.68%;among them,the global hardening rate<5%has 11 cases,5-10%has 31 cases,10-25%has11 For example,there are 3 cases in 25-50%,and only 1 case in?50%;30.2%(67cases)had intrarenal vascular thickening;32 cases had IgA deposition alone,with the most deposition of IgM(72.5%),followed by C3 deposition(72.1%);IgA was deposited directly in the system.The ratio of membrane area was 51.8%,the proportion of capillary sputum deposition was 48.20%;the dose of IgA immunofluorescence was 2+,accounting for 55.0%;in all cases with IgG deposition,IgG immunofluorescence intensity 1 The number of+accounted for 83.1%of all cases;IgG immunofluorescence intensity±5.6%,2+accounted for 11.2%.(4)Correlation analysis between clinical manifestations and pathological changes:With the increase of age,there was no significant change in the number of patients with Lee grade;with the increase of urine protein levels,the proportion of Lee's ?-? grade increased significantly,with statistically significant differences;There was a significant difference in the proportion of Lee's grading in children with hypertension and normal blood pressure.With the increase of CKD stage,Lee's grading was aggravated,and there was statistically significant difference;hyperuricemia and hypoalbuminemia in renal biopsy Symptomatic and hypercholesterolemia were positively associated with Lee's grade(P<0.001);however,there was no correlation between cholesterol and uric acid in the normal range and Lee's grade(P=0.739 and0.183,respectively);There were no correlations between M,E,S,and T in all pathological indexes of Oxford(P>0.05).Patients with hypertension during renal biopsy had a higher probability of M1 lesions,E1 lesions and T1 lesions(P<0.001).),but no correlation with S1 lesions(P=0.155);M1 and S1 lesions were not associated with CKD stage(P 0.979 and 0.510,respectively);E1 and T1 lesions were negatively correlated with CKD stage(P=0.001)There was a positive correlation between M1and E1 lesions and hyperuricemia,hypercholesterolemia and urinary protein levels(P<0.05).There was a significant correlation between S1 lesions and hypercholesterolemia.T1 lesions and other indicators were present.Significantly correlated;crescentic lesions(C)were positively correlated with hypertension,hyperuricemia,hypercholesterolemia,and urinary protein quantification,and were not associated with age and eGFR;intrarenal artery disease(A)and hyperuricemia,high Cholesterolemia was positively correlated with blood pressure,serum albumin,urinary protein levels,and eGFR;glomerular global sclerosis was positively associated with hyperuricemia,hypoalbuminemia,and eGFR,with blood pressure,hypercholesterolemia,and urine.There was no correlation between protein quantification,age,and eGFR.(5)Correlation analysis of clinical manifestations,pathological changes and immunofluorescence:IgA with IgM or C3 deposition,IgA deposition intensity and IgA with vasospasm deposition in hypertension and immunofluorescence were positively correlated with IgG deposition;high uric acid There was a positive correlation between serum and IgM,IgG,C3 deposition and IgA with vasospasm deposition,and no correlation with IgA deposition intensity;hypoalbuminemia was negatively correlated with IgM,C3 deposition and IgA deposition intensity,with vasospasm deposition.There was no correlation with IgG deposition;hypercholesterolemia was positively associated with C3 deposition and vasospasm deposition,and was not associated with IgM,IgG deposition,and IgA deposition intensity;urinary protein levels were associated with IgM,IgG,and IgA with vasospasm There was a positive correlation between deposition and C3deposition and IgA deposition intensity;eGFR was positively correlated with IgA with vasospasm deposition,and had no correlation with IgM,C3 deposition,IgG deposition and IgA deposition intensity;There was no correlation between age and immunofluorescence pathology;Lee's grade was significantly correlated with IgM deposition,C3 deposition,IgA deposition intensity,IgA with capillary vasospasm(P<0.05),and no significant correlation with IgG deposition(P).=0.172);Oxford M1lesions were positively correlated with C3 deposition and IgA deposition intensity(P<0.001),and had no significant correlation with IgM,IgG and IgA with capillary vasospasm(P>0.05);Oxford classification E1 lesions There was a positive correlation between IgA deposition intensity and IgA with capillary sputum deposition(P<0.05),and no correlation with IgM,IgG and C3 deposition(P>0.05);S1 lesion and IgA deposition intensity,whether with IgM,IgG and C3 deposition There was no correlation between IgA capillary sputum deposition(P>0.05);T1lesions were associated with IgG and C3 deposition(P<0.05),and were not associated with IgM,IgA deposition intensity and IgA with capillary vasospasm(P>0.05).lgG deposition was not associated with global sclerosis(P=0.182);IgG deposition was associated with crescentic lesions and intrarenal artery disease(P<0.05);lgM deposition was associated with crescent(P=0.000);There is no correlation between IgM deposition and global sclerosis and intrarenal artery disease(P>0.05);IgA deposition intensity was positively correlated with crescentic lesions(P=0.045),and had no correlation with global sclerosis and intrarenal artery disease(P>0.05);C3 deposition was positively correlated with crescent(P>0.05).=0.011),no correlation with global sclerosis and intrarenal artery disease(P>0.05);IgA with capillary vasospasm was positively correlated with glomerular global sclerosis(P=0.032).There was a positive correlation between lgA and capillary sputum deposition and intrarenal artery disease and crescent(P<0.05),which was not related to global sclerosis(P=0.220).(6)Lee's classification,Haas's classification and Oxford's classification of pathological indicators also have significant correlation and good consistency.Conclusion:Conclusion:1.The incidence of gross hematuria in primary IgAN in 222 children in Jiangxi is high.2,a large number of proteinuria,hypertension,eGFR decline,hyperuricemia,hypoalbuminemia,and hypercholesterolemia are factors that cause serious pathological damage.3,IgA with C3 deposition,IgA with capillary vasospasm deposition,clinical and pathological performance is more serious. |
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