Clinico-pathological Characteristics,Outcome And Related Risk Factors Of IgA Nephropathy With Wind-dampness Syndrome

Objective To investigate the clinico-pathological characteristics,outcome and related risk factors of IgA nephropathy(IgAN)with wind-dampness syndrome.Methods One thousand one hundred and eighteen patients with primary IgAN in Hangzhou hospital of traditional Chinese Medicine between 2001 and 2007 were retrospectively studied.The clinical pathologic characters of wind-dampness IgAN patients(n=377)and non-wind-dampness IgAN patients(n=741)decided by Wang Yongjun five-element syndrome differentiation standards were analyzed.Renal survival was calculated by Kaplan-Meier survival analysis and risk factors of progression were analyzed by using univariate and multivariate Cox regression models.Results(1)Compared to non-wind-dampness IgAN patients,wind-dampness IgAN patients had a significant difference in age,sex,systolic pressure,diastolic pressure,proteinuria,serum creatinine,serum uric acid,total cholesterol,Serum levels of triglyceride,serum albumin and glomerular filtration rate(P<0.05).Pathological indicators showed,a higher percentage of global glomerulosclerosis,and higher incidence of glomerulosclerosis,tubular atrophy,interstitial fibrosis,fibrous crescent,fibro(cellular)crescents,renal vascular lesions in wind-dampness IgAN patients than non-wind-dampness IgAN patients.The active lesions showed,interstitial inflammatory cells infiltration,mesangial hypercellularity,endocapillary hypercellularity,cellular(fibrillar)crescent in wind-dampness IgAN patients were worse than non-wind-dampness IgAN patients.(2)The follow-up time of 1118 IgAN patients was 7.5 years.The 1,5,10 year cumulative renal survival rates of wind-dampness patients were 99.5%,95.4%and 72.7%respectively,while.The wind-dampness patients were 99.9%,98.1%and 89.6%respectively.Compared to non-wind-dampness IgAN patients,wind-dampness IgAN patients had a significant difference in 10 year cumulative renal survival rates(P<0.01).(3)Among syndrome and sign of traditional Chinese medicine,the wind-dampness and liver-wind were independently associated with long-term outcome of IgAN(P<0.05).The risk prognostic factor of wind-dampness IgAN was 3.2 time higher than non-wind-dampness IgAN.Multivariate Cox regression data showed,hyperuricemia,impaired renal function,interstitial fibrosis,Tubular atrophy,glomerulosclerosis were the independent risk prognostic factor.Conclusions Wind-dampness syndrome was the key point to IgAN.Wind-dampness IgAN patients were worse than non-wind-dampness IgAN patients in clinical pathological changes,pathological chronic renal lesions and active lesions.Impaired renal function,hyperuricemia,glomerulosclerosis,interstitial fibrosis,tubular atrophy were the independent risk prognostic factor of IgAN.