Pathological And Clinical Characteristics Analysis Of 2078 Renal Biopsy Cases And Prognostic Analysis Of IgA Nephropathy

Part1:Pathological and Clinical Characteristics Analysis of 2078 Renal Biopsy asesBackground and AimsThe development of percutaneous renal biopsy is of great importance for clinical diagnosis,treatment and prognosis.The study about the change of disease spectrum can provide more reference for the diagnosis of diseases in Jiangmen,which can improve the level of treatment and prevention greatly.There are so many studies about spectrum of kidney disease from different cities in China,but none about the spectrum of Jiangmen was reported so far.Since the 20th century,percutaneous renal biopsy technology and related work had been carried out actively in Jiangmen Central Hospital.However,there was lack of systematic retrospective analysis about the renal biopsy cases in this region.Therefore,this project mainly explores the epidemiology and clinical characteristics of patients in the center,in order to provide more reference for the treatment and prevention of renal diseases in this region.MethodsThis study included 2078 patients who received renal biopsy from January 1,2011 to December 30,2020 in our center.The pathologic classification of renal biopsy was performed by light microscopy,immunofluorescence and electron microscopy,according to the modified 1995 glomerular disease tissue classification scheme of WHO and the guidelines for pathological diagnosis of renal biopsy formulated in China in 2001.Exclusion criteria:(1)the number of glomerulus under light microscope≤8;(2)patients whose clinical and pathological diagnosis is still unclear.The general information,clinical manifestations and test results of the cases were collected.EXCEL and SPSS 21.0 software were used for statistical analysis.The measurement data were presented as mean±standard deviation;the counting data was presented as rate;the normal distribution was presented as mean±standard deviation;the non-normal distribution was presented as M(P25,P75);and the counting data was presented as rate.Results1.Clinical characteristicsFrom January 1,2011 to December 30,2020,there were 2085 patients who received renal biopsy in our hospital.Because of insufficient sample or missing clinical data,7 patients were excluded and 2078 patients were finally included.The average age was 41.50±15.86 years(6-84 years),with 1042 males(50.14%)and 1036 females(49.86%),with 1739 primary glomerular diseases(83.68%)and 314 secondary glomerular diseases(15.17%).There were 19 cases of tubulointerstitial disease(0.86%),5 cases of genetic and congenital nephropathy(0.24%).The top three primary glomerular diseases were Ig AN with 565 cases(32.42%),MN with 499 cases(28.69%),and MCD with 409 cases(23.52%).The top three secondary glomerular diseases:140 cases of LN(44.3%),80 cases of DN(25.95%),and 26 cases of renal amyloidosis(8.22%).The characteristics of age:the highest incidence group of patients with MCD and HSP is<18 years old,the highest incidence group of patients with Ig AN and LN is18-44 years old,the highest incidence group of patients with DN is 45-59 years old,and the highest incidence group of patients with MN,crescentic glomerulonephritis and renal amyloidosis is 60-85 years old(p<0.05).There was no significant difference in the constituent ratio of other types of glomerular diseases in different groups.Compared with the previous five years(2011-2015)and the last five years(2016-2020),there was no significant difference in the composition ratio of overall renal disease(P>0.05),but in the group of last five years,the proportion of hereditary and congenital nephropathy increased(0 vs 0.4%).For primary glomerular diseases,the proportion of membranous nephropathy increased significantly in the last five years(24.7%vs 32%).For secondary glomerular diseases,the proportion of lupus nephritis decreased slightly(51.6%vs 40%).2.Clinical features of primary glomerular diseaseAmong patients with primary glomerular disease,the most common pathological type of chronic nephritis syndrome was Ig AN(28.57%,62.3%,33.1%)in juvenile group,youth group and middle-aged group,and membranous nephropathy(32.9%)in elderly group.The common pathological type of nephrotic syndrome was minimal lesion nephropathy in the juvenile group(66.1%),membranous nephropathy in the youth group,middle-aged group and elderly group(36.6%,58.2%,67%).The most common pathological type of acute renal injury was minimal lesion nephropathy(50%,28.6%,28.1%,31.5%).Four types of primary glomerular diseases were included for comparative analysis of clinical characteristics.Except Ig AN,the proportion of males was higher than that of females in the other pathological types.The average urinary erythrocyte count of patients with Ig AN was 48.0(14.0,145.5)/HP,which was significantly higher than that of other types.The average age of patients with MN was older(53.01±8.12years old),and the levels of various blood lipids were significantly higher than those of other types.The average e GFR of patients with focal segmental glomerulosclerosis was 64.7ml/min·1.73m~2(36.6,98.6ml/min·1.73m~2),which was significantly lower than that of other types.(P<0.001)3.Comparation between primary glomerular disease and secondary glomerular diseaseCompared with primary glomerular disease,hypertension was more common in secondary glomerular disease(44.27%vs 29.84%),nephrotic syndrome complicated with acute kidney injury(18.47%vs 6.15%),and lower e GFR(35.67%vs 20.64%)occurred more commonly(p<0.05).Conclusion In this study:1.The number of renal biopsy is on the rise,and the proportion of older patients increased.2.Primary glomerular disease is still the principal component,among which Ig A nephropathy is the most common,meanwhile membranous nephropathy is on the rise.3.In primary glomerular diseases,the incidence of acute kidney injury is significantly higher in the elderly people.4.It is worth noting that the clinical presentation of secondary glomerular disease is more severe,compared with primary glomerular disease.Part2:Prognostic Analysis of Ig A NephropathyOxidative stress and inflammatory response have been confirmed to be related with the occurrence and progression of Ig A nephropathy.However,there are few studies on the correlation between the prognosis of Ig AN and oxidative stress or nutrition.Therefore,the purpose of this study is to investigate the effect and possible pathway of oxidative stress and geriatric nutritional risk index on the prognosis of Ig A nephropathy,in order to provide some help for the accurate treatment and prevention of Ig A nephropathy.MethodsBiopsy-proven patients with Ig A nephropathy were investigated and followed up for more than 12 months.End points of follow-up:(1)creatinine level doubled from baseline at renal biopsy;(2)ESRD was defined as EGFR<15ml/min·1.73m~2 or entering renal replacement therapy.Follow up contents:end time,blood pressure,blood creatinine,urinary protein,etc.The patient’s survival time was from renal biopsy to the end date or follow-up deadline(December 31,2021)Pearson and Spearman correlation analysis was used to study the correlation between serum creatinine level and clinical indexes in patients with advanced Ig A nephropathy.The risk ratio(HR)of each factor was calculated by univariate Cox regression,and the survival curve was drawn by Kaplan Meier method to analyze the effects of different SOD levels and GNRI grouping on patients’survival.Variables with significant differences in univariate analysis,oxidative stress and nutrition related variables were included in multivariate Cox regression model to further clarify the independent risk factors related to prognosis.The Bootstrap model was used to explore the mediating effect on correlation between GNRI and serum creatinine.The p value less than 0.05 was considered statistically significant.ResultsCorrelation analysis between s Cr level and clinical indexes in patients with Ig A nephropathy with progressive renal insufficiency.Serum creatinine was negatively correlated with hemoglobin and albumin,and positively correlated with urinary protein,age,triglyceride,uric acid and C-reactive protein(P<0.05).Gender,proteinuria,hypertension,Hb,ALB,TG,uric acid,GNRI,superoxide dismutase and NLR are the prognostic factors of patients with Ig A nephropathy.After multivariate correction showed a 2%risk decrease for every 1U/L increase in SOD(HR 0.98,95%CI 0.96～1,P=0.015),the risk of doubling creatinine decreases by 5%for every 1 increase of GNRI(HR 0.95,95%CI 0.91～1,P=0.038).For every1U/L of SOD increase,the risk of entering ESRD decreased by 3%(HR0.97,95%CI 0.94～0.99,P=0.003),per 1 increase in GNRI,the risk of entering ESRD decreased by 8%(HR 0.92,95%CI 0.87～0.97,P=0.004).Completely standardized indirect effect of GNRI on serum creatinine via SOD is 15.3%(95%CI=[-0.2911,-0.0701]).Conclusion1.SOD is an independent risk factor for doubling creatinine,entering ESRD in patients with Ig A nephropathy.2.GNRI is an independent risk factor for doubling creatinine,entering ESRD in patients with Ig A nephropathy.It may affect the prognosis of Ig AN through oxidative stress in some degree.Conclusion of full text:In this study:1.The number of renal biopsy is on the rise,and the proportion of older patients increased.2.Primary glomerular disease is still the principal component,among which Ig A nephropathy is the most common,meanwhile membranous nephropathy is on the rise.3.In primary glomerular diseases,the incidence of acute kidney injury is significantly higher in the elderly people.4.It is worth noting that the clinical presentation of secondary glomerular disease is more severe,compared with primary glomerular disease.5.SOD is an independent risk factor for doubling creatinine,entering ESRD in patients with Ig A nephropathy.6.GNRI is an independent risk factor for doubling creatinine,entering ESRD in patients with Ig A nephropathy.It may affect the prognosis of Ig AN through oxidative stress in some degree.