Clinical And Pathological Analysis Of Tubulointerstitial Injures In Immunoglobulin A Nephropathy

Object：IgA nephropathy (IgAN) is the most common primaryglomerulonephritis, which is characterized by predominant IgA depositionin the glomerular mesangium, and the typical focal or diffuse mesangialcell proliferation and matrix expansion in light microscopy. This disease isfirst described by two French scientists J.Berger and N.Hinglais in1968, soits also called the Berger’s disease. IgAN runs a highly variable clinicalcourse and the process, and they are not correspondence bwtween eachother. It’s one of the common reasons which can lead to end-stage renaldisease (ESRD). In China, it comprises a main part in primary glomerulardisease. At the beginning, the histopathologic researches are focused onglomerular injury, but in recent years, researches showed that the severityof tubulointerstitial lesion correlates more closely with renal progression toESRD. The Oxford classification of IgAN, developed by International IgANephrology Network in2009,containes four histopathologic parameters:mesangial hypercellularity (M0/1), endocapillary hypercellularity (E0/1),segmental glomerulosclerosis(S0/1), and tubular atrophy and interstitial fibrosis(T0/1/2).Now, the Oxford classification of IgAN is considered to bea more reliable and valuable method to evaluate the degree ofhistopathologic lesion of IgAN worldwide.Our research studied on the associations of the tubulointerstitial lesionwith clinical、laboratory and histopathological data in123patients from theFirst affiliated hospital of Chongqing medical University. Refering Oxfordclassification to histopathologic characteristics of tubulointerstitial injury.Clinical、laboratory and histopathological data were compared in differentgroups of tubulointerstitial injury degree. Aimed to investigate the Clinicalsignificance of tubulointerstitial injury.Methods: Clinical、laboratory and histopathological data of123patients with primary IgAN from the First affiliated hospital of Chongqingmedical University which had been diagnosed by renal biopsy from Mar2011to Dec2012were reviewed retrospectively.Results：1. Study on the clinical data:There were55male patients and68femal patients, with the ratio ofmale to femal0.8:1.The onset of IgAN was generally in all age, with the highestpercentage of33.3%in31~40years old. The onset age ranged from14~67years old, mean age33(25,41) years old. The course of the disease rangedfrom2day to20years,and the mean course6(1,24) months. 2. Study on the laboratory data:The incidence of protein urine (100%) was the highest one among anyother clinical manifestations, while the incidence ofhypertriglyceridemia(13.8%) was the lowest. The incidence of anemia was35%. The incidence of renal insufficiency was21.1%. The incidence ofhyperuricemia was51.2%. The incidence of hypoproteinemia was22%.The incidence of high cholesterol was19.5%. The incidence of renalinsufficency was increased with the increase of age.3. Study on the histopathological data:Among all the123IgA patients, the patients with tubulointerstitiallesion accounted for30.89%, T1group was21.95%,T2group was about8.94%.4. Study among the clinical、laboratory and histopathological data:(1)With the severity of tubulointerstitial lesion, the level ofhemoglobin and the count of red blood cell decrease. The differencebetween groups with tubulointerstitial lesion(T1and T2group) and non-tubulointerstitial lesion(T0group) were significant(P<0.05) in hemoglobinlevel, and it wasn’t more significant between T0and T2group(P<0.01).While the difference between of red blood cell count only significantbetween T0and T2group.(2)The level of serum uric acid increases along with the increase oftubulointerstitial lesion, there were significant difference between T0and T1group(P<0.05).(3) The groups with tubulointerstitial lesion(T1and T2group) had ahigher level of serum creatintine and blood urea nitrogen than non-tubulointerstitial lesion(T0group)(P<0.05). While there was nosingnificance between T1and T2group.(4) In our research, other clinical and laboratory data (patients age, thecourse of disease, serum total protein, serum albumin, blood totalcholesterol, blood triglycerides,24hours urinary protein quantitative) hadno significant difference with the degree of the renal tubule interstitiallesions.5.Correlation analysis among the clinical、laboratory andhistopathological data:In our research, the Pearson correlation analysis suggested a negativecorrelation between the tubulointerstitial lesion and HGB、RBC level（P<0.01）, while there is a positive correlation between the UAlevel withthe tubulointerstitial lesion（P<0.05）. The Spearman correlation analysissuggested positive correlation between the Scr、BUN level with thetubulointerstitial lesion（P<0.01）. Positive correlation between age、proteinuria and tubulointerstitial lesion（P<0.05）.Conclusions：The tubulointerstitial lesion existed in general IgApatients. With the increase of tubulointerstitial lesion, the clinical conditionbecomed worse. The tubulointerstitial lesion may be one of the key factors for the prognosis of IgAN. The epidemiology and clinical、histopathological features in our study were basically consistent with theother literatures about the IgA nephrology.