Analysis On Clinical And Pathological Data Of Patients With Abnormal Renal Function

Objective:In order to study clinical characteristics and pathological distribution of patients with abnormal renal function who undergoing renal biopsy in the past 10 years in our center,the clinical and pathological data of 4122 patients were retrospectively analyzed.Differences of renal pathological spectrum between the renal dysfunction group and the control group were compared,as well as the patients in different estimated glomerular filtration rate levels of renal dysfunction group.Hoping to guide the diagnosis and treatment of patients undergoing renal biopsy with abnormal renal function.Methods:The clinical and pathological data of 4122 patients undergoing renal biopsy in the Department of Nephrology of the Second Hospital of Jilin University from January 2008 to December 2017 were retrospectively analyzed.According to the serum creatinine level,the patients were divided into renal dysfunction group and control group,and spectrums of renal disease was compared between these two groups.According to the glomerular filtration rate,patients with abnormal renal function were divided into group A and group B,then analysis the differences of pathological distribution in these two groups.Results:(1)In our center,there were 4,122 cases who undergoing renal biopsy with complete data in 2008-2017,including 854 cases in renal dysfunction group and 3268cases in control group.The proportion of patients with renal dysfunction in the past10 years increased significantly.The proportion of primary glomerulonephritis in males was higher than that in females,and the proportion of secondary renal disease in females was higher than that in males(p<0.01).The young and middle-aged group(15-49 years old)has the highest proportion of renal disease,accounting for 63.39%.3083(74.79%)were primary glomerulonephritis of the 4122 renal biopsies,924(22.42%)were secondary renal disease,108(2.62%)were tubular interstitial nephropathy and 7(0.17%)were hereditary nephropathy.The proportion of IgA nephropathy showed a downward trend in 10 years,and the proportion of membranousnephropathyincreasedsignificantly.Theproportionof Henoch-Schonlein purpura nephritis has a significant downward trend in 10 years,and there is a slight increase in the proportion of diabetic nephropathy.(2)The comparison between the renal dysfunction group and the control group showed that the proportion of males,average age and the percentage of elderly patients(≥60 years)in the renal dysfunction group were significantly higher than those in the control group(p<0.01).The proportion of primary glomerulonephritis in the renal dysfunction group was lower than that in the control group(p<0.01),and the proportion of secondary renal disease and tubular interstitial nephropathy was higher than that in the control group(p<0.01).The primary glomerulonephritis with the highest proportion in renal dysfunction group were IgA nephropathy(167/35.31%)and membranous nephropathy(65/13.74%).The proportion of IgA nephropathy,focal segmental glomerulosclerosis,membrano-proliferative glomerulonephritis,crescentic glomerulonephritis,proliferative sclerosing glomerulonephritis and sclerosing glomerulonephritis in the renal dysfunction group was higher than that in the control group(p<0.01),while the proportion of membranous nephropathy,glomerular minor lesion and minimal change disease was lower(p<0.01).The secondary renal disease with the highest proportion of renal dysfunction were lupus nephritis(77/26.83%)and ANCA-associated nephritis(55/19.16%).The proportion of diabetic nephropathy,ANCA-associated nephritis and malignant nephrosclerosis was higher in the renal dysfunction group than that of control group(p<0.01).The proportion of lupus nephritis,Henoch-Schonlein purpura nephritis,and hepatitis B virus associated nephritis was lower than that in the control group(p<0.01).The proportion of pathological types in tubular interstitial nephropathy was no statistically significant difference between these two groups(p>0.05).(3)Among 854 patients with abnormal renal function,473(55.39%)were diagnosed with primary glomerulonephritis,287(33.61%)were secondary renal disease and 94(11.00%)were tubular interstitial nephropathy.IgA nephropathy and membranous nephropathy were the main pathological types of primary glomerulonephritis,and lupus nephritis and ANCA-associated nephritis were the main pathological types of secondary renal disease.The average age of the patients was45.37±16.24 years;males accounted for 64.05%;only 50.72%of the patients with a history of diabetes mellitus were confirmed to have diabetic nephropathy.After comparison,we found that group A had lower level of hemoglobin,triglyceride,total cholesterol,24-hour urine protein than group B(p<0.01).The proportion of proliferative sclerosing glomerulonephritis and sclerosing glomerulonephritis as well as crescentic glomerulonephritis in group A were higher than those in group B(p<0.01).The proportion of focal segmental glomerulonephritis,IgA nephropathy and membranous nephropathy was lower in group A than in group B(p<0.05).The proportion of ANCA-associated nephritis and malignant nephrosclerosis in group A was higher than that in group B(p<0.05).The proportion of benign nephrosclerosis was lower than that in group B(p<0.01).Conclusions:(1)The proportion of membranous nephropathy in our center has exceeded IgA nephropathy in recent five years and became the main pathological type of primary glomerulonephritis.(2)The proportion of renal biopsy patients with renal dysfunction has increased significantly in the past 10 years in our center.(3)Patients with renal dysfunction and the history of diabetes mellitus should be alert to non-diabetic nephropathy.(4)IgA nephropathy is the main pathological type of primary glomerulonephritis in patients with abnormal renal function who undergoing renal biopsy.Lupus nephritis and ANCA-associated nephritis are the main pathological types of secondary renal disease in patients with abnormal renal function who undergoing renal biopsy.(5)Patients with abnormal renal function in our center,especially those with glomerular filtration rate less than 30 ml/min/1.73m~2,had a large proportion of proliferative sclerosing glomerulonephritis and sclerosing glomerulonephritis.