Analysis Of The Clinical Characteriscts And The Oxford Classification Of 192 Patients With IgA Nephropaty From Shanxi Province

Background and Objective:IgA nephropathy is the most common primary glomerul disease worldwide, and is also the main cause of end stage renal disease. Now it is considered to be a clinicopathological syndrome with the same immune-histological feature, characterized by deposits of IgA with or without other immune-complex in the mesangium of the glomerulus. The disease has lots of various clinical presentations and histological lesions. A renal biopsy is required for an accurate diagnosis of IgA nephropathy and the degree of the histological lesions plays an important role on prognosis and treatment of the disease. Now there is no international consensus for IgA nephropathy pathological classification.The Oxford pathological classification for IgA nephropathy was presented by an international consensus working group in 2009. In this research we analysis the clinical characteristics and Oxford pathological classification of 192 patients with IgA nephropathy proven by renal biopsies in our hospital retrospectively, to confirm the Oxford classification with good clinical guide of treatment and prognosis of IgA nephropathy.Methods:192 patients with IgA nephropathy from the second hospital of Shanxi medical university which had been proven by renal biopsy between Mar 2003 and Dec 2010 were reviewed. The clinical and pathological data at the time of renal biopsy were analyzed. We described the clinical characteristics and pathological lesions in IgA nephropathy, assessed whether clinical presentations (age, gender, course of disease, blood pressure, uria red blood cell, 24-hour proteinuria, serum creatinine, serum albumin, triglyceride, cholesterol, eGFR) correlated with the pathological lesions (Oxford pathological classification, renal vascular injury, global sclerosis, cellular/fibrocellular crescents) using the software SPSS 17.0.Results:①According to our information, the ratio of male to female was 1.2:1, the average incidence age was 31.8±11.9 years old(8-60 years old), the peak incidence age was 21-40 years old(60.0%). the average incidence age of male lower than the average incidence age of female (P<0.05). The median duration was 6.5 months (2d-10years).②Clinical presentations were various. The incidence of gross hematuria was 26.6%, more common in younger patients. Proteinuria with hematuria was the most common presentation, the incidence of it was 77.6%, the incidence of proteinura alone and hematuria alone was 16.1% and 6.3% respectively.28 cases (14.6%) performed as nephrotic syndrome. The incidence of renal function insufficiency was 15.1%. The percentage of CKD 1-5 stage was 55.7%,26.1%,9.9%,7.8% and 0.5%. The incidence of hypertention was 37.5%. The incidence of high triglycerideria and high cholesteria was 38.5% and 20.3%.③The incidence of Ml was 60.0%, the incidence of E1 was 55.2%, the incidence of S1 was 46.9%, the incidence of T0, T1 and T2 was 59.9%,22.9%, 17.2%. Pathological lesions such as renal vascular injury, global sclerosis, cellular/fibrocellular crescents were also common in IgA nephropathy, the incidence of them was 48.1%,50.0%, 50.5%.④24h urinary protein excretion was associated with the mesangial hypercellularity score, tubular atrophy or interstitial fibrosis and cellular/fibrocellular crescents. Blood pressure and renal function were associated with segmental sclerosis or adhesions, tubular atrophy or interstitial fibrosis, renal vascular injury, global sclerosis and cellular/fibrocellular crescents.⑤According to the Oxford classification, different types changed significantly in age, blood pressure, renal function.Conclusions:IgAN is the most common glomerulonephritis in China. The ratio of male to female is 1.2:1, the peak incidence age is 21-40 years old. Clinical presentations and pathological lesions are various. Proteinuria with hematuria is the most common presentation, the incidence of it is 77.6%,26.6% of the patients may have gross hematuria. There are 14.6% of the patients presented nephrotic syndrome and 15.1% of the patients with renal function insufficiency in our data. Pathological lesions are associated with clinical characteristics.24h urinary protein excretion is associated with the mesangial hypercellularity score, tubular atrophy or interstitial fibrosis and cellular/fibrocellular crescents. Blood pressure and renal function are associated with segmental sclerosis or adhesions, tubular atrophy or interstitial fibrosis, renal vascular injury, global sclerosis and cellular/fibrocellular crescents. The Oxford classification have good clinical guide of treatment and prognosis of IgA nephropathy.