Study On Clinical And Pathological Characteristics Of Henoch-schonlein Purpura Nephritis And IgA Nephropathy In A Multi-center

Objective:1.Retrospectively analyze the clinical and pathological data of patients with Henoch-Schonlein purpura nephritis and Ig A nephropathy in a Multi-center,compare the differences between them and summarize the pathogenesis of Henoch-Schonlein purpura nephritis;2.Retrospectively analyze the relationship between the clinical characteristics of Henoch-Schonlein purpura nephritis and pathological grades of the kidney,find clinical indicators related to the pathological grade of the kidney,add more reference data to the clinical diagnosis.Methods:1.The Clinical,laboratory and pathology data of 80 cases of Henoch-Schonlein purpura nephritis and 354 cases of Ig A nephropathy who were diagnosed in Jilin Top Three Hospital from September 2013 to September 2019 were collected.2.Use SPSS 25.0 statistical software to establish a database and perform statistical analysis:(1)to Analyze the pathological characteristics,clinical characteristics,laboratory tests,pathological data of HSPN and Ig A nephropathy,and the pathological characteristics of HSPN.(2)80 patients with HSPN were classified pathologically according to ISKDC classification standard and Bohle A classification standard,Compare the pathological grades of glomeruli and tubules with age,blood pressure,body mass index(BMI),proteinuria,albumin and glomerular filtration rate(GFR),and look for clinical indicators related to glomerular,tubule pathological grade.Results:1.In this study,there were 80 HSPN patients and 354 Ig A nephropathy patients.The male to female ratio in the HSPN group and the Ig A nephropathy group were 1: 1.74 and 1.14: 1,respectively,and there was a difference between the two groups(P <0.05).The average ages of patients with HSPN and Ig A nephropathy were 38(25,57)years and 37(27,47)years.The two groups were the most in the 18-44 year-old age group,and the differences in age between the two groups were statistically significant(P <0.001).More common in spring and summer.2.Allergies and upper respiratory tract infections are more common in HSPN patients.The history of allergies is significantly different from that in the Ig A nephropathy group(P<0.001).The rash and extrarenal manifestations of HSPN patients were significantly different from those of patients with Ig A nephropathy(P <0.05).Most patients had gross or microscopic hematuria;The quantitative analysis of urinary protein was?1.0g / d,among which 1.0~3.5g / d accounted for 51.5%.3.Patients with HSPN had higher white blood cell counts,high-sensitivity C-reactive protein,and D-dimer levels than those with Ig A nephropathy(P<0.05),and serum creatinine and urea nitrogen levels were lower than those with Ig A nephropathy,with less severe renal impairment and hypertension And less hypertriglyceridemia(P <0.05).4.HSPN and Ig A nephropathy have similar renal pathologies,but the proportion of HSPN cellular crescents,endothelial cell proliferation,and vascular climbing necrosis is higher than that of Ig A nephropathy,while the proportion of glomerulosclerosis(mainly glomerular global sclerosis),the proportion of tubular atrophy,The range of inflammatory cell infiltration and mesangial proliferation was milder than that of Ig A nephropathy,and the differences were statistically significant(P<0.05).The complement C3 deposition was less than that of Ig A nephropathy group(P <0.05);5.The glomerular pathological grade of HSPN patients and Ig A nephropathy was more common in grade III,accounting for 78.75% and 36.72%,respectively(P<0.05).Bohle A has the highest grade of ++,accounting for 66.25% and 50.28% each.There was a significant difference between Bohle A classification between the two groups(P <0.05);6.The ISKDC classification of HSPN patients was different in different groups of urine protein quantification and glomerular filtration rate(P<0.05).ISKDC classification was positively correlated with 24-hour urine protein quantification,urine transferrin,uric acid,urea nitrogen,creatinine,and fibrinogen degradation products,and negatively correlated with albumin and glomerular filtration rate(P<0.05).Among them,urinary transferrin,urinary microalbumin,urea nitrogen,FDP and ISKDC classification were strongly correlated.Bohle A classification was correlated with creatinine and glomerular filtration rate(P<0.05).There is a correlation between Bohle A classification and ISKDC classification(rs = 0.402,P = 0.000).Conclusion:1.The clinical manifestations of HSPN are similar to those of patients with Ig A nephropathy,which is more common in young people.The causes are mainly allergies and upper respiratory tract infections.Most patients have hematuria,and moderate to severe proteinuria is more common.2.Compared with Ig A nephropathy,HSPN has less damage to renal function,mainly acute lesions,and the incidence of renal tubulointerstitial damage is higher and less severe.3.ISKDC classification of HSPN patients was positively correlated with urine protein and renal function,and negatively correlated with albumin and e GFR;Bohle A classification was correlated with creatinine and e GFR.