Clinical And Pathological Features And Prognostic Factors Of Macrohematuria-induced Acute Renal Failure In IgA Nephropathy

ObjectiveTo investigate the clinical and pathological features of IgA nephropathy with macrohematuria-induced acute kidney injury and the influencing factors of renal function recovery.To find out a potential prognostic factors for its prognosis so that we can provide early treatment.MethodsWe performed a retrospective analysis of 30 patients on the clinical and pathological features of biopsy—proven IgAN diagnosed during 2001 to 2018,who had experienced macrohematuria-induced acute kidney injury.The clinical data of these patients were collected,including:1)General information:gender,age;2)Laboratory indicators: 24 hours urinary protein quantitative,baseline serum creatinine value,highest serum creatinine value,and twelfth month's serum creatinine value which was defined as that serum creatinine value was obtained after 1 year's followed up.We calculate the baseline and the twelfth month's glomerular filtration rate according to CKD-EPI formula;3)IgA nephropathy scores according Katafuchi semiquantitative criteria;4)Others:Reading the clinical data carefully,record the systolic pressure,diastolic blood pressure,duration of macrohematuria hematuria and hormones treatment.Patients were divided into two groups according to whether the final creatinine value recover to the baseline renal fuction(complete recovery of baseline renal function or incomplete recovery of baseline renal).Results 1?A complete recovering of baseline renal fuction was observed in 23,accounting for 76.7%.The remaining 7 patients suffered an incomplete recovering of baseline renal fuction(23.3%).There were no significant differences between two groups in gender,systolic pressure,diastolic pressure,24 hours urinary protein quantitative,hormones therapy,highest creatinine value(P > 0.05),while age,duration of macroscopic haematuria,baseline serum creatinine value,proporition of glomerular sclerosis and the severity of tubular necrosis had statistically significant.2?Compare to complete recovery of baseline renal function group,the other group were older and had a longer duration of macroscopic haematuria,a higher baseline serum creatinine value,a higher scores of glomerular sclerosis and tubular necrosis.3?Univariate analysis showed that age,duration of macroscopic haematuria,baseline serum creatinine value,baseline eGFR,glomerular sclerosis and the severity of tubular necrosis were the risk factors for an incomplete recovery of baseline renal fuction.By multivariate Logistic regression analysis,significant influences of baseline eGFR was found.Conclusion 1 ? A proportion(23.3%)of macrohematuria-induced acute kidney injury in IgA nephropathy did not recover baseline renal fuction after the disappearance of macroscopic hematuria.2 ? The longer duration of macroscopic haematuria,older,higher baseline serum creatinine value,lower baseline eGFR,more serious of glomerular sclerosis and tubular necrosis were the risk factors for an incomplete recovery of baseline renal fuction.