Clinical-pathological Features In Primary IgAN With Renal Vascular Lesions

Objective: To analyse the Clinical-pathological features of primary IgA nephropathy(IgAN) with different type of renal vascular lesions(RVLs).Methods:507 patients with primary IgAN proved by renal biopsy and clinical-manifestations were enrolled in this study (male:271cases, famale: 236 cases, Age: 11-68years). the patients were divided into four subgroups according to clinical features: urinary abnormality type (Uab), massive protein type (MP) , repeat gross hematuria type (RGH) and hypertensive type(HT).According to histological characteristics by light microscope, renal vascular lesions were divided into five subgroups: no renal vascular lesion (NRVL), hyalinosis (HL), arteriosclerosis (AS), celluar infiltration (CI) And fibroid necrosis (FN). Tubulointerstitial lesions were semi-quantitatively scored. Clinical and histological Characteristics were compared in different groups of renal vascular lesions.Results:(1)366 patients (72. 2%) were found to have renal vascular lesions. The incidence of HL, AS, FN and CI were 29. 8%, 27. 5%, 8.5% and 6.3%, respectively. There were 141 patients (27.8%) with NRVL.(2)In the patients with variant renal vascular lesions, the incidence of renal-insufficiency and hypertension were higher than that in NRVL group, so did urinary RBP (P<0. 05) .Urinary protein levels were lower than that in NRVL group. In FN group, the incidence of gross hameturia, malignant hypertension were 32.5% and 34.9% respectively, and in CI group they were 25 % and 9. 4% respectively. Both were significantly higher than that in any other groups (P<0. 01) .(D In the patients with renal vascular lesions, the incidence of global and segmental glomerulosclerosis were higher than that in NRVL group. In FN and CI group, the incidence of capilliary necrosis (20%, 18.7%), crescent ( 48.8%and 34. 3%) were significantly higher than that in any other groups (P<0. 05) . And there were no difference of capilliary necrosis among AS, HL and NRVL group.? The tubulo-interstitial score were higher in AS> CI and FN groups (4.0±1.8, 5.0±1.3 and 5. 1 + 1.5) than that in NRVL group (P<0. 01) . The tubulo-interstitial score were higher in HL group than that in NRVL group (2.9+1.5 vs 1.5 + 1.3, P<0.05) .Conclusions: In primary IgAN, Renal vascular lesions are very common. Renal vascular lesions parallels the clinical and renal histopathology features. And may be hlpeful to define the...