Clinicopathological Features And Prognostic Factors In Patients Of IgA Nephropathy With Hyperuricemia

Objective: to analyze the clinical and pathological features of IgA nephropathy with hyperuricemia,and to explore the effect of hyperuricemia on the prognosis of IgA nephropathy.Methods: patients admitted to the first affiliated hospital of Fujian Medical University from January 2006 to December 2016 who were confirmed with IgA nephropathy by renal biopsy and pathology in our hospital were included.All patients were followed up,and clinical indicators such as serum creatinine were monitored every 3-6 months,and the end point was the increase of creatinine by more than 1 times or the entry into ESRD or renal replacement therapy.The survival rate was analyzed by Kaplan-Meier method,and the risk factors affecting prognosis were analyzed by stepwise Cox regression model.231 patients with IgA nephropathy are successfully incorporated into,according to the blood uric acid levels in patients were divided into high blood uric acid and uric acid in the normal group,record all gender,age,when the renal biopsy in patients with systolic pressure,diastolic pressure,24 hours urinary protein quantitative,blood uric acid,urine occult blood,serum creatinine,serum albumin,hemoglobin,serum total cholesterol and other clinical indicators.All patients underwent renal pathological examination and Oxford type classification,and the clinical and pathological characteristics of IgA nephropathy patients in the two groups were statistically analyzed.Results:1.A total of 231 patients met the diagnostic criteria for IgA nephropathy and were successfully followed up for more than 2 years or entered the endpoint event with complete data,including 92 patients in the hyperuricemia group(39.8%)and 139 patients in the normal uric acid group(60.2%).2.The prevalence of hyperuricemia in IgA nephropathy patients was statistically significant between different CKD stages(P<0.001),from stage CKD1 to stage CKD3,and the proportion of hyperuricemia increased as the grade of chronic kidney disease increased.3.The proportion of male patients with IgA nephropathy and hyperuricemia was significantly higher than that of the normal uric acid group,and the difference was statistically significant(P<0.05).Systolic blood pressure,diastolic blood pressure,serum creatinine,blood urea nitrogen,24-hour urine protein and eGFR in the IgA nephropathy group with hyperuricemia were all higher than those in the normal uric acid group,with statistically significant differences(P<0.05).4.The degree of tubule atrophy/interstitial fibrosis in the IgA nephropathy group with hyperuricemia was higher than that in the normal uric acid group,and the difference was statistically significant(P<0.05).There was a difference in pathological Lee's grade between the two groups(P<0.05),and the proportion of grade IV pathological Lee's in the hyperuricemia group was significantly higher than that in the normal uric acid group.5.Among 231 patients with IgA nephropathy,122 were male,accounting for 52.1%,and 109 were female,accounting for 47.9%.A total of 29 patients entered the endpoint event.Univariate COX regression analysis showed that there were significant differences between the progressive group and the non-progressive group in glomerulosclerosis,renal tubular atrophy/interstitial fibrosis,24-hour urine protein quantification,hyperuricemia,anemia,hypertension,blood creatinine,and blood urea nitrogen,with statistically significant differences(P<0.05).6.In univariate analysis of disease progression in patients with IgA nephropathy,the prevalence of hyperuricemia was significantly higher in the disease progression group than in the non-progression group [18 cases(62.1%)vs.74 cases(36.6%),P=0.010].Kaplan-Meier survival curve suggested that renal survival was lower in IgA nephropathy group with hyperuricemia.Through multivariate COX regression analysis with stepped-correction,the final results were not able to confirm that hyperuricemia was an independent risk factor for disease progression in patients with IgA nephropathy,which may be related to inadequate sample size.7.In the multivariate analysis of the prognosis of IgA nephropathy in this study,anemia,24-hour urine protein,glomerulosclerosis(S),and serum creatinine showed statistically significant differences between the progressive group and the non-progressive group(P<0.05).The above are independent risk factors for the disease progression of IgA nephropathy patients.Conclusion:1.IgA nephropathy with hyperuricemia is associated with blood pressure,renal function,and 24-hour urinary protein.IgA nephropathy with hyperuricemia is characterized by severe renal pathology,especially tubular atrophy/interstitial fibrosis.2.Renal prognosis of IgA nephropathy patients with hyperuricemia is poor.Anemia,serum creatinine,24-hour urine protein and glomerulosclerosis are independent risk factors for the progression of IgA nephropathy.