Clinical And Pathological Characteristics And Prognosis Of IgA Nephropathy Patients With Hyperuricemia

Objective:To understand the clinical and pathological characteristics of patients with IgA nephropathy complicated with hyperuricemia,and to analyze the effect of serum uric acid on the prognosis of IgA nephropathy.Methods:Retrospective cohort study.A total of 718 patients with IgA nephropathy who were diagnosed by renal biopsy and followed up for more than 1 year in the department of nephrology of Ningxia medical university general hospital during the period from August 1,2008 to December 31,2018 were included.The study end point was doubling of creatinine or end-stage renal disease.According to baseline uric acid and time mean blood uric acid level(TA-SUA)quarteter spacing,four groups were divided into four groups.The baseline data of the four groups were compared,and kaplan-meier method and Cox regression model were used to investigate the relationship between high uric acid level and prognosis in patients with IgA nephropathy.Results :(1)A total of 718 IgAN patients were included in this study,of which 181(25.21%)were hyperuricemia patients.(2)According to the baseline uric acid and TA-SUA quartile spacing,they were divided into group q1-4 from low to high.Compared with other three groups,group Q4:To increase proportion of male,smoking,drinkers,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),urea nitrogen(Bun),creatinine(Scr),triglyceride(TG),hemoglobin(Hb),estimated glomerular filtration rate(eGFR)is low,the renal tubular atrophy/fibrosis degree heavier,in addition,in TA-SUA subgroups,mesangial cells is heavier,degree of segmental glomerular sclerosis(p < 0.05).(3)Kaplan-meier survival analysis showed that the Q4 group had the worst prognosis in either the baseline serum uric acid level group or the TA-SUA group.(4)Serum uric acid levels and the prognosis of relationships: single factor COX regression model analysis of SBP,DBP,MAP,baseline SUA,high SUA levels,glomerular filtration rate and serum albumin,24 hours urinary protein,renal tubular atrophy/quantitative fibrosis are dangerous factor driing the progression of IgA nephropathy,multifactor result prompt adjustment for age,sex,alcohol consumption,propagated,24 hours urinary protein quantitative,TG and other factors,the baseline SUA is not independent risk factors for renal outcomes for patients with IgAN.Subgroup analysis: the results of univariate Cox regression model analysis suggested that SBP,SUA,high TA-SUA level,glomerular filtration rate,24-hour urinary protein quantification,glomerular segment sclerosis,renal tubular atrophy/interstitial fibrosis were all risk factors for renal prognosis of IgA nephropathy.After incorporating the above factors into the multivariate Cox regression model and adjusting for age,gender,alcohol consumption,systolic blood pressure,eGFR,TG and other factors,the risk of renal outcome in group Q4 was 2.95 times that of group Q1(HR 2.95,95%ci1.02-8.53,p=0.046).High TA-SUA is an independent risk factor for renal prognosis in IgAN patients.Conclusion: Patients with high serum uric acid level in IgA nephropathy had more severe clinical and pathological damage.TA-SUA was an independent risk factor for renal prognosis in patients with IgA nephropathy,while baseline SUA level,after adjustment for renal function,was not an independent risk factor for renal prognosis in IgAN patients.IgA nephropathy hyperuricemia is closely related to lifestyle,gender,blood pressure,triglyceride,24 h urine protein quantification and serum albumin.