Clinicopathological And Prognostic Study Of Focal/Proliferative IgA Nephropathy

AimTo retrospectively analyze the clinical manifestations,TCM syndromes and prognosis of patients with focal/proliferative sclerosing IgA nephropathy in the context of chronic pathological changes,and to explore the impact of TCM treatment and immunosuppressive therapy on their prognosis Provide reference for clinical prevention and treatment of IgA nephropathy and further prospective research.MethodsUsing retrospective research methods,from September 1,2005 to December 31,2017,all patients in Guangdong Provincial Hospital of Traditional Chinese Medicine diagnosed with focal/proliferative sclerosing IgA nephropathy by renal biopsy,a total of 105 patients were eligible Standards enter this study.Collect and organize demographic data,clinical data,TCM syndromes and other relevant baseline indicators of patients with renal puncture,and summarize the clinical manifestations and TCM syndromes of different degrees of active lesions of kidney pathology under different chronic pathological changes;During follow-up,the clinical data during the follow-up period,the situation of Chinese and Western medicines,etc.were collected.The prognostic analysis was performed by using Kaplan-Meier analysis and Cox regression analysis with the composite end point indicators of blood creatinine doubling,eGFR decline≥50%,ESRD and death.ResultsA total of 105 patients with focal/hyperplastic sclerosis were included in this study.The median follow-up time was 37(27.5,59)months.A total of 35 patients(33.3%)had a composite endpoint.According to the active pathological scale,58 cases(55.2%)were mild,30 cases(28.6%)were moderate,17 cases(16.2%)were severe;34 cases(32.4%)had a proportion of spherical sclerosis(abbreviation:Ball hard ratio)>50%,71 cases(67.6%)patients with a ball hard ratio of 25%-50%.Among patients with a ball-hardness ratio of>50%,21 cases(61.8%)were mildly active and 13 cases(38.2%)were moderately severe(Figure 3);25%-50%of patients were active 37 cases were mild(52.1%),21 cases were moderate(29.6%),and 13 cases were severe(18.3%).In terms of baseline analysis,there were significant differences in the history of hypertension,blood pressure,blood creatinine;eGFR,and fibrinogen in the group of globular sclerosis;comparison of active groups in different chronic backgrounds,urine protein quantification,urine red blood cell count,and urine protein of different molecular weights,Blood protein,total cholesterol,low-density lipoprotein cholesterol,and blood IgG all have significant differences in the active group;in terms of TCM syndromes,focal/hyperplastic sclerosis type IgA nephropathy are all true and false evidences,and the main evidences are The manifestation of deficiency syndrome is mainly of lung and spleen qi deficiency,and the symptoms all have or both blood stasis syndrome and damp heat stasis syndrome.In the prognostic analysis,higher baseline blood pressure,proteinuria with different molecular weights,urine protein quantification,blood creatinine,blood uric acid,and lower blood albumin,glomerular filtration rate were associated with endpoints.The KM survival curve indicates that the greater the proportion of ball hardness,the greater the activity,the higher the C and T scores,the worse the prognosis;the prognosis of the spleen and kidney yang deficiency syndrome of traditional Chinese medicine is poor;whether taking hormones and/or immunosuppressive therapy has a prognostic There is no difference;in patients with deficiency of lung and spleen qi,the prognosis is better with the method of promoting blood circulation and removing blood stasis than without the method of promoting blood circulation and removing blood stasis.In the multivariate analysis of COX regression,in terms of T score,taking T0 as a reference,T2(HR:14.189,95%CI:1.451-138.768,P=0.023)at the same time the risk of a composite endpoint event increased by 14.1.9 times;blood Creatinine and systolic blood pressure are independent risk factors for prognosis,and taking angiotensin Ⅱ receptor antagonists as protective factors.ConclusionIn the context of chronic pathological changes,different degrees of active lesions are correlated with clinical indicators of Chinese and Western medicine.Hormonal and/or immunosuppressive therapy has no effect on the prognosis.The prognosis of spleen and kidney yang deficiency syndrome in traditional Chinese medicine is poor.The method of activating blood circulation and removing blood stasis can improve the prognosis of patients with deficiency of lung and spleen qi.Serum creatinine and systolic blood pressure are independent risk factors affecting prognosis,and angiotensinⅡ receptor antagonists are protective factors.