The Study Of Clinical Manifestation,Renal Pathology And TCM Syndrome Of IgA Nephropathy With Partial Crescent Formation

BackgroundIgA nephropathy is a kind of chronic and progressive glomerular disease,which is the leading cause of End-stage renal disease in China.IgA nephropathy prognostic factors consist of clinical manifestation and renal pathology.In 2009 the Oxford classification of IgA nephropathy that International IgA nephropathy cooperation group and kidney pathology association published considers mesangial cells proliferation(M),endothelial cells proliferation(E),glomerular sclerosis(S),renal tubular interstitial fibrosis or tubular atrophy(T) as pathological factors of IgA nephropathy prognosis.Crescent formation isn’t considered as the pathological factor of IgA nephropathy prognosis and included in the Oxford classification.Crescent formation is one of the common characteristic of IgA nephropathy pathological change.The issue that whether crescent formation affects the prognosis of IgA nephropathy or not is controversial,it isn’t elaborated in the Oxford classification.The cognition of IgA nephropathy with crescent formation is from crescentic glomerulonephritis that is IgA nephropathy with more than 50% of crescent formation.Rapidly progressive nephritic syndrome is the main clinical manifestation of crescentic glomerulonephritis.The crescentic glomerulonephritis is with rapid decline in renal function and poor prognosis.But in clinical this type of IgA nephropathy is in the minority,accounting for 3.14% of all kinds types of IgA nephropathy.Its clinical manifestation、renal pathological feature-treatment and the prognosis are referred as RPGN.Most clinical researchs excluded the type of IgA nephropathy.The majority is IgA nephropathy with 50% and less than 50% of crescent formation.For the clinical manifestation,pathological characteristics.IgA nephropathy prognosis and treatment of traditional Chinese medicine in regard to IgA nephropathy with 50% and less than 50% of crescent formation are rarely reported. Western medicine treatment of IgA nephropathy with 50% and less than 50% of crescent formation isn’t clarified definitely.While this research explores and analyzes the clinical feature,renal pathological characteristics and TCM syndrome differentiation of 50% and less than 50% crescent formation of IgA nephropathy, in order to evaluate the prognosis of this type of IgA nephropathy and provide more evidence in the diagnosis and treatment of traditional Chinese and western medicine.ObjectiveTo explore the correlation between partial crescent formation and clinical indicators,renal pathological feature and TCM syndrome differentiation in patients of IgA nephropathy with partial crescent formation.MethodsIn retrospective study,clinical indicators,renal pathological feature and TCM syndrome differentiation were studied for IgA nephropathy with or without partial crescent formation,and clinical manifestation,renal pathological feature and TCM syndrome differentiation were studied for IgA nephropathy with different proportion crescent were analyzed.Results1 clinical manifestation,renal pathological feature and TCM syndrome for IgA nephropathy with or without partial crescent formation210 biopsy-proven cases were primary IgA nephropathy from January 2011 to October 2015 in Guang’an men hospital,China academy of traditional Chinese medicine science.With the exception of 4 crescentic glomerulonephritis cases,206 cases were included in the study.Among them,115 cases with partial crescent formation were included in the study accounting for 54.8% of the overall IgA nephropathy cases. IgA nephropathy with and without partial crescent formation were compared as follows:1.1 Basic materialsThere was no statistical difference between sex, age, precursor infection status,naked eye hematuria and IgA nephropathy with and without partial crescent formation(P>0.05).There was statistical difference between course of the disease and IgA nephropathy with and without partial crescent formation(P< 0.05). Course of the disease in IgA nephropathy with partial crescent formation patients was ranged from 3 days to 20 years,the median duration of the disease was 7 months.Course of the disease in IgA nephropathy without crescent formation patients was ranged from 6 days to 25 years.the median duration of the disease was 18 months.The proportion of tonsil swollen of IgA nephropathy patients with crescent formation patients was higher than IgA nephropathy without crescent formation patients(P<0.05).1.2clinical indicatorsserum creatinine、IgA/C3 in IgA nephropathy patients with partial crescent formation were higher than that in IgA nephropathy patients without partial crescent formation; eGFR、HGB in IgA nephropathy patients with partial crescent formation were lower than that in IgA nephropathy patients without partial crescent formation(P < 0.05).There were no statistical difference between 24-hour urine protein quantitative,urine protein classification,UA,CHO, TG, LDL, IgA, C3,systolic blood pressure, blood pressure level and CKD stage(P>0.05).1.3renal pathology1.3.1renal pathological typeThe main pathological types of IgA nephropathy cases with partial crescent formation were focal proliferative type and focal proliferative sclerosis type.The main pathological types of IgA nephropathy cases without crescent formation were focal proliferative type and mild mesangial proliferative type.There was statistical difference in two groups (P<0.05).1.3.21ee classificationLee classification in IgA nephropathy with partial crescent formation was heavier than that without crescent formation(P<0.05).IgA nephropathy patients with partial crescent formation were focused on Lee III and above.IgA nephropathy patients without crescent formation were focused on Lee II and above.1.3.3Katafuchi integralThe inflammatory cells infiltration integral,renal interstitial fibrosis integral and renal tubular atrophy integral in IgA nephropathy with partial crescent formation patients were higher than in IgA nephropathy without crescent formation patients(P< 0.05).1.4 TCM syndrome differentiationThere was statistical significance between syndrome of TCM and with and without partial crescent formation(P< 0.05).Yang deficiency of spleen and kidney syndrome was the most syndrome in IgA nephropathy cases with partial crescent formation.The most syndrome was qi and Yin deficiency syndrome in IgA nephropathy cases without crescent formation.Damp-heat and blood stasis syndrome were the main sthenia syndromes in IgA nephropathy cases with and without partial crescent formation.There were no statistical difference in two groups (P>0.05).2The correlation between partial crescent formation and clinical indicators,renal pathology and TCM syndrome differentiationIn accordance with crescent formation proportion,115 cases were divided into group A^ group B, group C.42 IgA nephropathy cases(36.5%) with less than 10% crescent formation,were referred as group A;56 cases(48.7%)with crescent formation proportion between 10% and 30%, were referred as group B;17 cases(14.8%)with crescent formation proportion between 30% and 50%, were referred as group C.Group A、group B、group C were compared as follows:2.1 The correlation between partial crescent formation and clinical indicators2.1.1 The correlation between partial crescent formation and urine proteinThere was significant relationship between different proportion crescent and 24-hour urine protein quantitative.urine protein classification (P<0.05).24-hour urine protein quantitative in group C was higher than in group A(P<0.05);the proportion of urine protein level 2 and 3 patients in group C was higher than that in group A(P< 0.05).2.1.2 The correlation between partial crescent formation and renal functionThere was significant difference between crescent formation and eGFR, serum creatinine level(P<0.05).The eGFR in group B and group C was lower than that in group A (P<0.05).SCr in group B was higher than that in group A (P<0.05).2.1.3The correlation between partial crescent formation and other clinical indicatorsThere was significant correlation between partial crescent formation and HGB、 plasma albumin(P<0.05).HGB、plasma albumin in group C were lower than those in group A and group B.There were no statistical difference between partial crescent formation and UA,CHO,TG,LDL,IgA,C3,IgA/C3,systolic blood pressure、blood pressure level and CKD stage(P>0.05).2.2The correlation between partial crescent formation and renal pathology2.2.1The correlation between partial crescent formation and lee classificationThere was significant difference between different proportion crescent and Lee classification(P< 0.05). Lee classification in group C was higher than that of group A and group B(P<0.05).2.2.2 The correlation between partial crescent formation and Katafuchi integralThere was no statistical difference along Group A, group B and group C on glomerular integral、renal tubular interstitial integral and vascular integral(P> 0.05).While the increase of crescent proportion,inflammatory cells infiltration,renal interstitial fibrosis and renal tubular atrophy lesions integral were higher.2.3 The correlation between partial crescent formation and TCM syndrome differentiationThere was no statistical significance between different proportion crescent and deficiency syndrome of TCM(P> 0.05). While the increase of crescent proportion,the proportion of patients with Yang deficiency of spleen and kidney syndrome was higher.There was statistical significance between crescent formation and wind-heat syndrome in group A、group B、group C(P<0.05).Conclusions1 Compared with IgA nephropathy without crescent formation, IgA nephropathy patients with partial crescent formation had poor renal function, sever renal tubular interstitial lesion and lee classification; Yang deficiency of spleen and kidney syndrome was the most deficiency syndrome. Damp-heat syndrome and blood stasis syndrome were the main ones in sthenia syndrome of TCM.2Clinical manifestation,renal pathology,TCM syndrome differentiation of IgA nephropathy patients with different proportion crescent were as follows:2.1 With the increase of crescent proportion, IgA nephropathy patients had higher 24-hour urine protein quantitative and serum creatinine, lower eGFR、plasma albumin and HGB, severer lee classification(P<0.05).2.2There was statistical significance between partial crescent formation and wind-heat syndrome(P<0.05).