Analysis Of Influencing Factors Of Renal Tubulointerstitial Damage In Patients With Primary IgA Nephropathy

Background: IgA nephropathy is the most common type of primary glomerular disease and one of the causes of progression to end-stage renal disease.However,the progress of IgA nephropathy is not entirely associated with glomerular lesions.And in some patients,the renal function continues to decline despite controlled glomerular lesions,which may be related to tubulointerstitial damage.Objective:The study compares the clinical manifestations,biochemical indicators,pathological characteristics of patients with primary IgA nephropathy to explores the factors associated with renal tubular interstitial damage to clinically assess the condition of patients with IgA nephropathy.Methods: A retrospective,single-center study included 223 patients with primary IgA nephropathy who underwent renal puncture pathology within five years.According to Oxford pathological staging,they were divided into two groups,one group with no or mild tubulointerstitial damage(T0≤25%)and one group with medium and severe tubulointerstitial damage(T1-2>25%).By analyzing the patients’ clinical manifestations,biochemical indexes,and pathological data,comparing the differences between the two groups,and the correlation between each index and interstitial tubular damage in patients with IgA nephropathy was assessed by logistic regression analysis.And the predictive value of relevant indexes on interstitial tubular damage in patients with IgA nephropathy was assessed using ROC curves.Results: 223 patients were divided into group T0(164)and group T1-2(59).The rate of renal tubulointerstitial damage was 26.46%.The Comparison of general information:The median age of patients in the T0 group was 34(26,44),the median age of patients in the T1-2 group was 34(26,43),and the male to female ratio was 1.21:1.There was no difference in age and gender between the two groups.Statistical significance(P>0.05).There was no significant difference in the days of onset of the disease between the two groups(P>0.05).The comparison of clinical data:27 patients(16.46%)were infected in group T0 and 11 patients(18.64%)were infected in group T1-2.The difference was not statistically significant(P>0.05).The levels of systolic blood pressure,diastolic blood pressure,serum creatinine,24-hour urine protein quantification,and average arterial pressure in group T1-2 were higher than those in group T0(P<0.05);the levels of albumin and hemoglobin in group T1-2 were lower than those in group T0.The difference was statistically significant(P<0.05);the levels of globulin,white sphere ratio,total cholesterol,triglycerides,total protein,blood uric acid,blood urea nitrogen,bicarbonate,complement C3,complement C4,serum IgA,Ig G,Ig M,and IgA/C3,was not statistically significant between group T0 and group T1-2(P>0.05).The comparison of Pathological data:In terms of renal pathological changes,the endocapillary hypercellularity(E),Segmental glomerulosclerosis(S),inflammatory cell infiltration,and complement C3 deposition in group the T1-2 were more severe than those in group T0.The difference of pathological changes were statistically significant(P<0.05).There was no significant difference in mesangial hypercellularity(M),crescent(C),Ig G deposition,Ig M deposition,and IgA deposition intensity(P>0.05).Multivariate logistic regression analysis showed that the level of serum creatinine and hemoglobin are independent predictors of chronic tubular interstitial damage in patients with primary IgA nephropathy.Increased diastolic blood pressure,anemia,Endocapillary hypercellularity(E),segment al glomerulosclerosis(S),and complement C3 deposition are independent risks of chronic tubulointerstitial damage in primary IgA nephropathy(P<0.05).Conclusion: Tubulointerstitial damage is a common pathological manifestatio n in patients with IgA nephropathy,and it is related to the progression and prog nosis of IgA nephropathy.Hemoglobin and blood creatinine are independent predic tors of tubulointerstitial damage in patients with primary IgA nephropathy.24-hou r urine protein quantification are risk factors influencing tubulointerstitial damag e in patients with IgA nephropathy.Increased diastolic blood pressure,anemia,en docapillary hypercellularity(E),segmental glomerulosclerosis(S)and complement C3 deposition are independent influencing factors of tubulointerstitial damage in I g A nephropathy.Clinically,The degree of progression of IgA nephropathy can be a ssessed clinically by monitoring the level of blood creatinine,e GFR,hemoglobin,and 24-hour proteinuria quantification.Early treatment can be given include lowe ring urine protein,controlling blood pressure,improving anemia,anti-inflammatio n and immunosuppression.