Correlative Analysis Of Serum Uric Acid Level In IgA Nephropathy And Clinical, Pathological And TCM Syndromes

BackgroundIgA nephropathy is the most common idiopathic glomerulonephritis in China. It s generally considered that 24-hour urine protein>1g, high blood pressure, elevated serum creatinine, severity of kidney pathology are independent risk factors for the prognosis. In recent years, some experts tend to treat hyperuricemia as a independent risk factor for the renal prognosis. Increased uric acid can lead to the lesion of renal tubules, glomeruli and renal arteries. Clinicians should pay more attention to the treatment of hyperuricemia.Angiotensin converting enzyme inhibitor(ACEI)/angiotensin â…¡ receptor blocker(ARB), glucocorticoid and immunosuppressive therapy are principally used for treating IgAN in western medicine. Lowering uric acid medication and basifying urine are the main treatment methods for hyperuricemia. Some clinicians have not pay enough attention to control the uric acid levels strictly for patients who are suffering from IgAN and hyperuricemia. On the other hand, there are few suggestions in dialectical treatment in treating IgAN with hyperuricemia in respect of Traditional Chinese Medicine (TCM). Analysis of the correlation between serum uric acid level and clinical indicators, renal pathology and syndrome differentiation of TCM is great essential to diagnosis, further treatment and evaluation of prognosis about the disease.This study collects 146 primary IgAN cases, analyse the correlation between serum uric acid degree and the clinical indicators, renal pathology and TCM syndrome differentiation in order to supply more evidence in instructing therepy and evaluating prognosis. ObjectiveTo explore the correlation between serum uric acid degree and the clinical indicators, renal pathology and TCM syndrome differentiation in patients of IgAN manifested with hyperuricemia.MethodsCollecting 146 biopsy-proven idiopathic IgAN cases from January 2011 to February 2015 in Guang anmen hospital, China academy of traditional Chinese medicine sciences.81 cases of patients with normal uric acid levels, referred as normal group; 65 cases with high uric acid, referred as high uric acid group. Then analyse the clinical indicators (24 hours urine protein, serum creatinine, blood urea nitrogen, renal function, blood pressure, serum protein, complement, hemoglobin, lipids), pathological features in the two groups retrospectively. Analyse the distribution of TCM syndrome in patients with IgA nephropathy and hyperuricemia.Results1.The correlation between serum uric acid and clinical indicators(1)Serum uric acid and renal function:there were significant relationships between uric acid levels and Scr, BUN, eGPR (P<0.05). In high uric acid group, the percentage of CKD1-5 stage were 23.1%,36.9%,27.7%,7.7% and 4.6% respectively, there were significant differences compared with the normal group(P<0.05).(2) Serum uric acid and 24 hours urine protein:there was a statistical significance in the 24h-UP degrees between the two groups (P=0.027), in which the median values are 1.69g and 1.16g, respectively.(3) Serum uric acid and hypertension:Overall prevalence of hypertension in high uric acid group was higher than the normal group (89.2%vs60.5%). The percentages of hypertension 1-3 stage were higher than the normal group, especially the 3 stage(33.8%vs13.6). There was a statistical significance in the hypertension degrees between the two groups (P<0.05).(4) Serum uric acid and serum lipids:there were statistical significances in triglyceride and high-density lipoprotein cholesterol degrees between the two groups (P<0.05). The median values of triglycerides are 1.69g and 1.16g. The median values of high-density lipoprotein cholesterols are 1.21mmol/1 and 1.07mmol/1. There were no statistical significances in total cholesterol and low density lipoprotein cholesterol degrees between the two groups (P>0.05).(5) There were no statistical significances in serum protein, complement C3 and C4, hemoglobin between the two groups (P>0.05).2. The correlation between serum uric acid degree and renal pathology(1)Among all cases, the most common renal pathology was the focal proliferative type, accounting for 71.2%. There were a few differences of pathologies between the two groups, but the most common was the focal proliferative type (75.3%vs66.2%), the overall pathological type had no statistical significance (P>0.05).7 cases(10.8%) were reported with acute/subacute renal tubulointerstitial disease in high uric acid group and 1 case(1.2%) was reported in normal group (P<0.05).9 cases (13.8%) were reported with ischemic renal injury in high uric acid group and 8 cases (9.9%) were reported in normal group (P>0.05).(2) The percentages of T1+T2 were 82.8% and 93.2% between the normal and high uric acid group (P<0.05). There were no significant correlation between uric acid and M, E, S (P>0.05).(3) The percentages of artery thickening and crescent were closely 95% and 60% (P>0.05).3. Distribution of TCM syndrome in patients with IgAN and hyperuricemia(1)Among the 65 cases, the most common TCM syndrome type was the Qi and Yin deficiency type (36.9%). The overall distribution of TCM syndrome differentiation was Qi and Yin deficiency> Yang deficiency of spleen and kidney> Yin deficiency of liver and kidney> Qi deficiency of lung and spleen> lower Jiao of damp and heat= exogenous pathogenic wind and heat.(2) Among the 65 cases,11 cases had any accompanying syndrome,31 cases had an accompanying syndrome,22 cases had two accompanying syndromes. The two most common accompanying syndromes were the syndrome of blood stasis and water wet, followed by blood stasis and hot-humid. Among all the accompanying syndromes, the most common-seen was the blood stasis syndrome (49.2%), followed by the damp-heat syndrome (30.8%).Conclusions1. In the patients wuth IgAN, there was a positive correlation between serum uric acid degree and 24h-UP, Scr, BUN, blood pressure and triglyceride. There was a negative correlation between serum uric acid degree and renal function and high density lipoprotein.2. In the patients with IgAN and hyperuricemia, the most common pathologic type was the focal proliferative type. There were no significant differences in overall distribution of pathological type of the two groups. Serum uric acid level had a obvious influence in renal tubular atrophy and interstitial fibrosis.3. In the patients with IgAN and hyperuricemia, the most common TCM syndrome type was the Qi and Yin deficiency type, while the most common accompanying syndrome differentiation was the blood stasis type, followed dy the dampness-heat type. Dampness and blood stasis were frequently accompanied.