Analysis Of Clinic And Pathology In 80 Cases With IgA Nephropathy

Background: IgAN is a group with the same pathological features of glomerular immune clinical syndrome, it is one of the most common primary glomerular diseases in the world, China is also a higher incidence of IgAN. Tracking IgAN more than 20 years, about 20-50% of patients progress to end stage renal failure. So far there is no effective treatment. Its clinical manifestation and renal pathology showed the diversity and variability, IgAN clinical performance and prognosis has the extreme imbalance, it is difficult to determine the degree of renal damage and prognosis just by a simple clinical indicator. But renal pathological grade is important to the assessment of prognosis.Objective: To analyze the clinical characteristics ,pathological features and its relevance of patients with IgA nephropathy, to find factors contributing to prognosis, to provide a basis for determining the pathogenetic conditions comprehensively, slowing down the progress of disease and guiding its treatment.Methods: A retrospective summary of the clinical, pathological and laboratory indicators of 80 cases of IgAN patients confirmed by renal biopsy examination in our hospita from September 2006 to December 2007 , including age, sex, blood pressure, serum creatinine, 24-hour urine protein level at the time of renal biopsy. Division of IgAN patients according to age, clinical features, Lee's grading system, immunoglobulin deposition type. The incidence of all ages to observe the characteristics of disease , the incidence of high blood pressure, serum creatinine, 24-hour urinary protein. Analysis of the epidemiological characteristics of IgAN, the relationship of the various pathological indicators, and the relationship between clinical indicator and pathological grade, statistical analysis of count data was performed usingχ2 test, the measurement data comparison among multi-groups using analysis of variance . Pvalue <0.05 was considered significantly.Results: 1. Clinical data analysis of 80 cases of IgAN patients: (1) General Information: incidence ratio of male and female was 1.5:1; average age is 32.4±12.5 years;in the group of all ages, with 20 to 30-year-old and 30-39- year-old making up of the most number of cases ,each the number of total cases of 33.75%, 25%, compared with each age group P <0.01 or P <0.05; men and women of all ages in the incidence of no significant difference (p> 0.05), the incidence ratio for men and women <20 years of age and the larger 20-29 age group; 1.67:1 ratio in urban and rural areas, urban and rural areas in the incidence of all ages there is no significant difference (P> 0.05), between the urban and rural areas the proportion of 21-29 year-old group to compare has significant difference (P <0.05).(2) Pre-onset manifestations: infection to onset to a maximum of incentives, the total number of cases of 72.5%, which accounted for 48.7% of respiratory tract infection. In the respiratory tract infection, tonsillitis total of 35% of cases, accounting for 71.8% of respiratory tract infections.(3) Abnormal renal function and urinary abnormalities and hypertension: 80 cases of IgA nephropathy patients with renal insufficiency accounted for 22.5% of patients with normal renal function group, in men, high incidence of more ages. Abnormal urine hematuria combined with proteinuria mainly renal dysfunction and the proportion of patients with the most (P <0.05). A large number of patients with proteinuria of at least a few cases, renal dysfunction but the largest proportion of persons, and light, moderate and severe proteinuria group emerged in patients with renal dysfunction gradually increase the proportion. 80 cases of IgAN patients with high blood pressure accounted for 47.5%, renal dysfunction appears more and more non-hypertensive group (P <0.05).2.80 cases of IgA nephropathy in patients with pathological data analysis: (1) 80 cases of IgA nephropathy in patients with Lee's pathological grades up to gradeⅢ,Ⅰ-class, V-class is relatively small; men and women of IgA nephropathy had no effect on the distribution of histological grade. Immunofluorescence ingredients: pure IgA with IgA and IgG, IgM, IgG + IgM, pure C3, fibrin-related products in the constituent ratio of the pathological grade, comparison groups were not significantly different (P> 0.05).(2) 80 cases of clinical manifestations of IgAN patients with occult nephritis accounted for 30.0%, mainly in pathological Lee'sⅠ-Ⅲlevel; performance nephritic syndrome accounted for 45.0 percent, the proportion of Lee's classification without significant difference; performance for nephrotic syndrome and renal dysfunction in Lee'sⅢ,Ⅳ,Ⅴclass-based; occur in patients with renal failure ratio increased with the pathological grade gradually increased, with normal renal function group more significant difference (P <0.05). (3) 80 cases of IgAN patients with pathological Lee's V grade 3 cases were all associated with high blood pressure. Pathology can be seen from the comparison of Lee's grade II-V the proportion of patients with high blood pressure gradually increased. Lee's IV pathological level, V-level incidence of hypertension was significantly higher than I level, II level (p <0.05 or p <0.01); of IgAN patients without hypertension pathology found Lee'sI-II level. IgAN with hypertension who prompted the classification of a high level of pathology.(4) 80 cases of IgAN patients with mild and moderate proteinuria group, Lee's II, III class found a large number of proteinuria in group III, IV level often. IgAN patients with proteinuria affect the degree of pathological grade (P <0.05).Conclusion:1 80 cases of IgA nephropathy in patients with onset between the ages of 20-29 in the largest proportion; more men than women, with onset of infection up to the incentive, especially respiratory infections.2 80 cases of IgA nephropathy in patients with clinical manifestations of diversity, uneven.①renal failure incidence in men than women in older patients with a larger proportion of the occurrence.②renal dysfunction in high blood pressure, persistent massive proteinuria occurred in a larger proportion.3 80 cases of patients with IgA nephropathy to Lee's histological grade III level in the main, men and women of the Lee's histological grade had no effect. Deposition of immunoglobulin type is unrelated to the injury and pathology.4 The degree of proteinuria, hypertension, renal function and renal pathology related to a certain extent.5 For patients with IgA nephropathy, renal biopsy should trip as soon as possible, and take effective measures to reduce the urinary protein and positive blood pressure lowering, thereby delaying the progress of renal insufficiency.6 The clinical performance of the joint integrated to determine the pathological grade condition.