| Objective:To create a novel theoretical foundation for the pathogenesis,treatment,and prognosis assessment of primary Ig A nephropathy(Ig AN),we will investigate the features of patients of Ig AN with Clq deposition in the mesangial region of kidney.Methods:From January l,2013 to December l,2022,412 patients with Ig AN confirmed by a kidney biopsy at the First Hospital of Jilin University were selected for a retrospective analysis.All those excluded from secondary Ig A deposition were divided into two groups,the Clq deposition positive group(46 cases)and the Clq deposition negative group(366cases),based on whether the glomerular mesangial area was accompanied by Clq deposition.Using SPSS25.0 software,acomparison was made between general clinical data,clinical classification,and pathological data for data research.Multivariate regression analysis was used to identify independent risk factors that could affect the estimated glomerular filtration rate(e GFR).Results:1.General data:(1)The average age of those with Clq deposition positive was(34.5±10.8)years,while the negative group was(38.4±13.7)years old,with no statistical difference(P>0.05);(2)The gender ratio of male and female in the positive group was 50%:50%,and that in the control group was 55.7%:44.3%,and there was no significant difference between the 2 groups(P>0.05);(3)The mean systolic and diastolic blood pressure of two groups were also basically the same(P>0.05);(4)Abnormal urine test type(U-ab type)was the most common clinical classification in both groups(P>0.05).2.Clinical data:(1)The positive group with Clq deposition exhibited lower plasma albumin and e GFR levels than the control group,Serum creatinine and 24-hour urine protein levels were higher than those in the negative group,and the difference was statistically significant(P<0.05);(2)There was no statistically significant difference between the level of hemoglobin,uric acid,total cholesterol and triglycerides(P>0.05);(3)There was statistical significance in Ig G level between groups(P<0.05),but the remaining serum immune complement(Ig A,Ig M,C3,C4)no have statistical differences;(4)CKD 4-5 phase is higher than the negative group(P<0.05).3.Pathological data:(1)The Oxford Type scores revealed that the positive group of Clq deposition had a greater proportion of mesangial cell proliferation(M1),endothelial cell proliferation(E1),segmental sclerosis and adhesion(S1),renal tubular atrophy(Tl～2),and crescent formation(C1>2)than the negative group,of which had significant differences between E1,T1～2 and C1～2(P<0.05);(2)There was a remarkable difference in Lee scores between the 2 groups(P<0.001);(3)In terms of glomerular complement immunofluorescence,there were no significant differences among Ig A and Ig M groups,while there were statistical differences among Ig G,C3,C4 and F groups(P<0.05).4.Multivariate regression analysis revealed that Ig AN patients’ mesangial region of the kidney with Clq deposition,Oxford classification score T1～2,and 24 h urine protein quantification were independent risk factor for e GFR progression.Conclusion:1.The U-ab type urine test is the primary clinical classification of Ig AN patients,implying that theonset of Ig AN is hidden and most don’t have visible clinical manifestation in the initial stages.2.Compared to the C1 q sedimentary negative group,patients with positive groups have more serious clinical manifestations and changes in kidney pathological changes,indicating that the classical activation pathway of complement system may participate in the onset and progress of Ig AN.3.C1 q deposition could be independent risk factor for progression of e GFR level,and patients with positive C1 q deposition are more likely to progress to end-stage renal disease.4.The clinical treatment and prognosis of Ig AN may be significantly impacted by C1 q deposition in the mesangial zone of the glomerulus. |
PDF Full Text Request