| Objective:To analyze the characteristics of renal histopathological changes,clinical manifestations and laboratory indexes of 343 primary IgA nephropathy in Liaoning province,and to further understand the characteristics of the IgA nephropathy in the region.In order to improve the level of diagnosis and treatment and improve prognosis of IgA nephropathy.Methods: A diagnosis of primary IgA nephropathy was made after renal biopsies in 343 patients in the General Hospital of Shenyang Military Region from January 2010 to December 2015.We collected and analyzed the clinical and pathological features.According to the Lee’s grading system to evaluate of renal pathological damage and grouping,investigate the relationship between clinical manifestations,laboratory indexes and pathological injury of each group.Result:1.IgAN accounts for 20.3%in all patients who underwent renal biopsyin the same stage of our hospital.The young male with the higher incidence,the ratio ofmale to female was 1.17:1 and the average age was 35.29±12.66.The age of onset focus on 20 to 40 years old,accounting for 62.4%in all patients.The mean course of disease was 17.74±35.43 months.2.This study case included all nephropathyhistological grading,among them the level Ⅲwas the most common one which is account to 58.6%.The pathological changes has covered almost all forms of renal pathology,while mesangial and stromal hyperplasia are the most common,accounting for 100%.The immune pathology was mainly IgA+IgG+IgM+C3(41.7%),and the fluorescence intensity distribution maintly focus on++-+++.In the all pathological grade of the complement C3 and IgA+++ are the most common,accounting for 80.2% and 81.3%.In addition,there was no significant correlation between sedimentation intensity and pathological grade(P>0.05).3.Primary IgA nephropathy onset hasoften conceal,this group of 79.6% of the patients have no obvious cause before the disease,62 cases(18.1%)patients have history of precursor infection.The most common clinical manifestations is asymptomatic abnormal urine test,account for 23.9%.The incidence of microscopic hematuriawith proteinuria is the most common urine test type,accounting for 60.4%.Level Ⅲ、Ⅳ+Ⅴwere the most common one in this grade.The gross hematuria average age is minimal and pathological damage is more lighter,comparison between groups was statistically difference(P<0.01).Half of the patients with normal renal function in renal biopsy,And we found that with the progress of renal function,the number of hypertension,UP > 2g/d and hyperuricemia patients increased gradually,but gross hematuria gradually reduced(P<0.01).Comparison of the group of CKD stage 1-2(n =260)andstage 3-5(n=83)showed that systolic bloodpressure,diastolic blood pressure,age,Cystatin-C,serum creatinine,urea nitrogen,uric acid and fibrinogen were significantly different between the groups(P<0.01).24-UP,hemoglobin and bloodIgA between groups were statistically significant difference(P<0.05).4.Lee’s grading system can more accurately reflect the degree of injury of renal tissue,there was a positive correlation between the pathological score of glomerular,renal tubular interstitial and renal vascular lesions and pathological grading(P<0.01).There was a positive correlation between the pathological grade and the degree of hypertension and urinary protein,and had a negative correlation with renal function(P<0.01).There was a significant correlation between the clinical indicators of IgA nephropathy and Katafuchi score of renal pathology.There was a significant correlation between urinary protein,renal injury,serum uric acid,blood pressure and pathologic score of renal tissues,andno significant correlation between serum calcium,serum IgA,blood C3 and IgA / C3 ratio(P>0.05).Conclusion:1.The primary Ig A nephropathy in Liaoning Province is mainly young people,their average age were 35.29±12.66 and the cause of the disease is usually unknown,the proportion of men and women similar.2.Hypertension has a wide range of damage to renal tissue,especially with renal vascular score has a significant positive correlation,suggesting that effective control of blood pressure may help to improve the long-term prognosis of IgA nephropathy.3.Age,blood pressure,early renal dysfunction,urinary protein,serum uric acid,fibrinogen,hemoglobin and serum IgA levels areimportant indicators of the IgA nephropathy development to more than CKD3 period.4.In this study,we found that the combination of Lee’s grading model and Katafuchi scoring system can be used to evaluate the degree of pathological damage of renal tissue more accurately,which is helpful to improve the accuracy of pathological diagnosis of IgA nephropathy. |
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