Analysis Of The Clinical-pathological Characteristics And Prognosis Of 742 Cases With Primary IgA Nephropathy

ObjectiveThe aim of the study was to further uncover the clinic-pathological features and prognostic factors of 742 cases with primary IgA nephropathy.Methods1)Participants The study population was all adult patients diagnosed with primary IgA nephropathy in the first affiliated hospital of Anhui Medical University between January 2015 and September 2019.The minimum follow-up of patients is 6 months.2)Research methods The clinicopathological data of 742 patients aged over 18 years undergoing renal biopsy were reviewed and all data were obtained at the time of renal biopsy.Patients’follow-up clinical outcome data were collected from August 2018 to March 2020.Patients were divided into group A[eGFR≥90 ml·min^-1·（1.73 m²）^-1],group B[eGFR 60-89 ml·min^-1·（1.73 m²）^-1]and group C[eGFR<60 ml·min^-1·（1.73 m²）^-1].Results（1）A total of 742 patients satisfied the inclusion and exclusion criteria of this study.The peak age of onset was 26 to 48 years and the sex ratio was 1:1.28 male to female.Asymptomatic abnormal urinalysis was the most common initial symptom（483 of 742patients,65.1%）,and 19.5%of patients had renal insufficiency.（2）As the baseline level of renal function decreased,the proportions of nephrotic syndrome,hypertension,anemia,hyperuricemia and the levels of 24 h urinary protein,serum triglyceride and total cholesterol increased significantly（all P<0.05）.Compared with the control group,patients with nephrotic syndrome or hypertension or anemia or hyperuricemia had a higher ratio of T1/T2（all P<0.05）.（3）For the aspect of pathological manifestations,the proportions of E1,S1,T1/2,globular sclerosis,renal arteriole wall thickening and vitreous degeneration,Lee’s grade Ⅳ and Ⅴ increased with the decrease of baseline renal function（all P<0.05）.Compared with the control group,patients with T1/2 or renal arteriole wall thickening had higher levels of 24h urinary protein and MAP,and had lower levels of eGFR（all P<0.05）.（4）The average follow-up time was 16 months and at the end of follow-up,77（10.3%）patients reached the primary combined outcome.Kaplan-Meier analysis showed that the 5-year cumulative renal survival rate decreased with the decline of baseline renal function（Log-rank χ²=88.510,P<0.001）.（5）Renal insufficiency,nephrotic syndrome,hypertension,IgG co-deposition and globular sclerosis were identified as independent risk factors for poor prognosis of primary IgA nephropathy.Conclusion（1）This region has a higher incidence of IgAN,which was characterized by hidden onset and a low awareness rate.（2）The level of baseline renal function in primary IgAN patients can be used to predict the extent of clinic-pathological damage.IgAN patients with renal dysfunction,nephrotic syndrome,hypertension,anemia and hyperuricemia had severe pathological damage.Meanwhile,patients with T1/2 or renal arteriole wall thickening had severe clinical damage.（3）Renal dysfunction,nephrotic syndrome,hypertension,IgG co-deposition and globular sclerosis were identified as independent risk factors for poor prognosis of primary IgA nephropathy.