The Clinical Indicators And Pathological Manifestations Of Foot Process In Patients With Primary IgA Nephropathy

Objective Primary IgA nephropathy is a kind of glomerular disease that Immunoglobulin A deposits in mesangial area or endocapillary wall with or without complement C3.It is one of the important causes of end-stage renal diseases.The new Oxford Classification in 2016 first proposed the role of podocyte in IgA nephropathy and subdivided segmental sclerosis/adhesion(S)into with/without podocyte hypertrophy or tip lesions.In recent years,how podocyte lesions play role in the occurence and development of lgA nephropathy has received more and more attention,and the search of key targets for podocyte lesions has become a hot issue At present,there are relatively few studies on the effect of podocyte injury on lgA nephropathy.It remains a question whether podocyte injury affects the developmant of lgA nephropathy or not.Therefore,this paper focused on the foot processes in renal biopsies of patients with lgA,and their correlation with baseline clinical indicators and pathological manifestations in patients with lgA is also covered.Method Data of patients who perfomed renal biopsy proven IgA nephropathy from April,2003 to January,2019 in the Second Affiliated Hospital of Fujian Medical University was selected,including baseline clinical indicators,pathological indicators.The patients who reached the agreed standard were grouped based on the degree of foot process.There were three groups(ABC Groups):group A for patients with no obvious foot process lesion;group B for patients with segmental foot process(<50%、>0);group C for patients with massive foot process(≥50%).The three groups were reviewed retrospectively in the aspects of baseline clinical indicators,pathological degrading,Oxford classification and the degree of foot process,so as to discover foot process’ effect on patients with IgA nephropathy.Results1.A total of 129 patients with IgA nephropathy were included in the study.Concerning about the clinical baseline indicators related to the degree of foot process,the 24-hour proteinuria level at admission was statistically significant and positively correlated(r=0.324,P=0.000).The comparison between groups showed there was statistically significant difference between group C and group A and group B(P=0.001,P=0.035).Other clinical indicators in the three groups didn’t show obvious differences.2.According to the Oxford Classification and Lee’s Pathological Grading,there were a comparative analysis of pathological baseline in groups with different foot processes.And only the differences of pathological grading,mesangial hypercellularity(M)and segmental sclerosis/adhesion(S)were statistically significant(r=0.251,P=0.004;r=0.239,P=0.006;r=0.257,P=0.003)and were positively correlated.The difference between group A and group C was statistically significant(P=0.041)in pathological grading.In terms of mesangial hypercellularity(M),the diferences between group A and B,group A and C were statistically significant(P=0.01,P=0.003).The comparison between group B and group C showed statistical difference(P-=0.031)in segmental sclerosis/adhesion(S).3.Among the 76 patients with S0 revealed by the Oxford classification,there were 55 patients of glomerulosclerosis,which was positively correlated with the degree of foot process(r=0.211,P=0.016).The comparison between group A and group C showed statistical difference(P=0.014).Conclusion1.The severity foot process was positively correlated with the level of proteinuria.2.Foot process is positively related with mesangial hypercellularity,segmental sclerosis and glomerulosclerosis.With more severe the foot process,there will be more serious mesangial hypercellularity and irreversible glomerular injury.3.Foot process is positively correlated with Lee’s Pathological Grading.The more obvious the foot process is,the more chronic the pathological change is.