Clinical Value Analysis Of Immunoglobulin Level In Patients With IgA Nephropathy

Objective:To analyze the clinical data,pathological features and independent influencing factors of renal tubular atrophy/interstitial fibrosis in patients with IgA nephropathy(IgAN)with different serum immunoglobulin levels.To provide a new noninvasive marker for pathological diagnosis,treatment of IgAN patients.Methods:The clinical laboratory data and pathological results of 315 patients with primary IgAN diagnosed from January 2017 to June 2021 were collected.The median of different serum immunoglobulin levels(g/l)was selected as the cut-off value and divided into high IgA level group and low IgA level group.High Ig G level group and low Ig G level group;High Ig M level group and low Ig M level group.T/χ~2test was used to analyze the differences of clinical and renal pathological data in different groups of patients.Multivariate regression analysis was used to explore the independent influencing factors of renal tubular atrophy/interstitial fibrosis(T),and receiver operating characteristic curve(ROC)curve was used to verify the specificity and sensitivity.Results:1.Sex,age,Body mass index(BMI),BMI),mean arterial pressure,hemoglobin,24h urinary protein,serum albumin,serum creatinine,blood urea nitrogen,blood uric acid,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,C3,estimated glomerular filtration rate(e GFR),Ig M,Chronic kidney disease(CKD).The levels of complement C4,cystatin-C and Ig G in high IgA level group were slightly higher than those in low IgA level group(P<0.05).2.Age,mean arterial pressure,hemoglobin,blood urea nitrogen,blood uric acid,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,C4 and IgA levels in the high Ig G level group were not statistically different from those in the low Ig G level group(P>0.05).The proportion of males,BMI,24-hour urinary protein,serum creatinine and CKD2-5 in low Ig G level group were higher than those in high Ig G level group,while the levels of C3,serum albumin,e GFR and Ig M were lower than those in high Ig G level group(P<0.05).The incidence of renal tubular atrophy/interstitial fibrosis(T1-2)in patients with low Ig G level was higher than that in patients with low Ig G level(P<0.05).3.There was no significant difference in age,BMI,mean arterial pressure,serum albumin,cystatin-C,total cholesterol,triglyceride,low density lipoprotein,C4 and IgA between the high Ig M level group and the low Ig M level group(P>0.05).The proportion of males,24h urinary protein,serum creatinine,serum uric acid and CKD2-5phase in low Ig M level group were higher than those in high Ig M level group,while the levels of high density lipoprotein,C3,e GFR and Ig G were lower than those in high Ig M level group(P<0.05).The incidence of renal tubular atrophy/interstitial fibrosis(T1-2)and crescent formation(C1-2)in patients with low Ig M level was higher than that in patients with low Ig G level(P<0.05).4.Low Ig M level,complement C3 and e GFR are independent influencing factors of renal tubular atrophy/interstitial fibrosis(T)in patients with primary IgAN(P<0.05).5.Ig M level,complement C3 level and e GFR can predict the existence of tubular atrophy/interstitial fibrosis(T).Conclusion:1.There is no significant statistical difference in clinical features and pathological types between serum IgA levels.2.The levels of Ig G and Ig M were low in renal biopsy,and the clinical renal injury was serious,and most of them had progressed to renal tubular atrophy/interstitial fibrosis.3.In patients with primary IgAN,the levels of complement C3,e GFR and low Ig M during renal biopsy are independent influencing factors for renal tubular atrophy/interstitial fibrosis(T).The sensitivity and specificity of diagnosing renal tubular atrophy/interstitial fibrosis(T)by complement C3 level are better.