The Effect Of Metabolic Syndrome On The Clinical,Pathological And Prognosis Of Patients With IgA Nephropathy

?Objective?To explore the clinical and pathological features of primary IgA nephropathy complicated with metabolic syndrome,and to explore the effect of metabolic syndrome on the clinical and pathological features and prognosis of IgA nephropathy.?Methods?98 cases of primary IgA nephropathy with complete data were selected from2007 to 2017 in the 900th Hospital of Lianqin support Center for renal biopsy and clinical data.49 of them were IgA nephropathy with metabolic syndrome,49patients with primary IgA nephropathy and 49 patients with non-metabolic syndrome of primary IgA nephropathy were randomly selected by SPSS software.The clinical and pathological data of the two groups were collected and analyzed statistically,and the components of metabolic syndrome and glomerular filtration rate(eGFR),were analyzed.The correlation of 24hour urine protein and semi-quantitative score of renal pathology was analyzed and the median follow-up time of the two groups was 5 years.?Result?1.Comparative analysis of clinical data:the quantity of BMI,BSA,MAP,FBG,UA,TA,24h urine protein in IgA nephropathy with MS group was significantly higher than that in IgA nephropathy group,and HDL-C was significantly lower than that in IgA nephropathy group.The difference between the two groups was statistically significant.Gender,age,glomerular filtration rate,urea nitrogen,total cholesterol,there was no statistical difference between the two groups.2.Comparison of renal pathology between the two groups:(1)there was no difference in the distribution of renal pathological lee grade between the two groups,and most of them were in grade IV;(2)the proportion of Mesangial cell proliferation(M1),segmental glomerulosclerosis(S1)and crescent-free(C0)were high in the Oxford typing of the two groups,and there was no significant difference between the two groups.The ratio of capillary hyperplasia,tubular atrophy and interstitial fibrosis in IgA nephropathy with metabolic syndrome group was higher than that in simple IgA nephropathy group,the difference was statistically significant.(3)comparison of semi-quantitative integral of renal pathology between two groups:total katafuchi integral,Mesangial proliferation integral,renal tubulointerstitial integral,interstitial inflammation cell integral,interstitial fibrosis integral;The renal tubular atrophy score in IgA nephropathy with MS group was significantly higher than that in IgA nephropathy group.There was no significant difference between the two groups in glomerular total score,segmental lesion score,ball sclerosis integral,vascular total integral,vascular wall thickening integral and hyaline change integral.3.The results of correlation analysis between the components of metabolic syndrome and eGFR,24h urinary protein and semi-quantitative integral of renal pathology were as follows:eGFR was positively correlated with HDL-C,but negatively correlated with age and MAP,UA,and 24h urinary protein was positively correlated with TG,UA Total katafuchi score was positively correlated with UA and negatively correlated with HDL-C,glomerular total score was positively correlated with UA(P<0.05),but negatively correlated with HDL-C.Tubulointerstitial score was positively correlated with BMI,UA(P<0.05),but negatively correlated with HDL-C,and vascular score was positively correlated with age and MAP.4.There was significant difference in survival curve between the two groups at the time of reaching two different endpoints:serum creatinine doubling(P<0.023),and secondary endpoint event eGFR?30 ml/min/1.73m~2(P<0.044),and there was a significant difference in the survival curve between the two groups(P<0.023).There was no significant difference in the time of reaching the secondary end point of ESRD(P=0.072),which defined as eGFR?15ml/min/1.73m~2 or starting dialysis or renal transplantation.?Conclusion?1.The clinical manifestations and renal pathology,especially tubulointerstitial lesions,in IgAN with MS group were more serious than those in simple IgAN group.2.There were significant differences in the prognosis of the two groups in the end-point event:the serum creatinine was doubled compared with the baseline value and the 5-year survival rate of egfr?30 ml/min/1.73m2 was significantly different,but there was no significant difference in esrd at the end-point event.