230Cases Of IgA Nephropathy:the Oxford Classification In Clinicopathological Analysis

Objective:IgA nephropathy, also known as Berger’s disease, is a form of glomerulonephritis characterized by biopsy-com-firmed deposition of the IgA antibody in the glomerulus. This disease first described immunologically by J. Berger and N. Hinglais in1968can be divided into primary IgA nephropathy and secondary IgA nephropathy. Primary IgA nephropathy is the most common primary glomeruiar disease worldwide. The prevalence is especially high in the Asian-Pacific region; IgA nephropathy cases comprise40%-50%nephropathy cases preforming biopsy in Japan and25%～30%in China. It occurs at any age,commonly with clinical onset in young adults (20～40years old)’,and pronely in male patients most.Exact causes of primary IgA nephropathy is unclear. There is also no characteristic clinical or pathological manifestations. A variety of systemic diseases are associated with secondary IgA nephropathy such as Henoch-Schonlein purpura (HSP), viral hepatitis, ankylosing spondylitis (AS), rheumatoid arthritis (RA), systemic lupus erythematous (SLE), mixed connective tissue disease (MCTD), poly-arteritis, psoriasis, tumor, etc. IgA nephropathy starts hidden and performances variedly; typical symptom is repeated gross hematuria or microscopic hematuria, while simple proteinuria, nephrotic syndrome, glomerulonephritis or renal insufficiency might also occur. A kidney biopsy is necessary to confirm the diagnosis. The specimen mostly shows IgA deposition based morphological structural change of the renal glomerulus. Reno-interstitial and renovascular change might also be observed.Methods:230IgAN patients from the Qilu hospital of Shandong University which had been diagnosed by renal biopsy between Jan2008to Dec2011. All of the clinical and pathologic information were analyzed by SPSS17.0.Results:1.According to the information,the incidence of IgA nephropathy in the Qilu hospital of Shandong University is about21.5%,with the ratio of male to female1.8:1,mean age34.9±11.331years,body weight71.24±14.192kg.Cause of the disease was18.17±34.672months; the onset of IgA nephropathy generally in young adults especially males about18～40years old。Hypertension and Renal insufficiency were the most clinical manifestations. Hematuria was significantly more in woman than in man, proteinuria Nephrotic syndrome did not show a difference. Hypertension and Renal insufficiency were much more common in elderly patients.The incidence of the mesangial hypercellularity、segmental glomerulosclerosis/adhesion and interstitial inflammatory cell infiltration are the most common pathological changes (>60%). The deposition of the IgA antibody in the glomerulus as granules is the most common type.3.According to the information, M was strongly associated with GFR、24-hour urine protein (P<0.05),E was strongly associated with GFR and the systolic blood pressure (P<0.05),S was strongly associated with Cholesterol、GFE (P<0.01),Twas strongly associated with SC、GFR、the systolic blood pressure and uric acid (P<0.01)The Deposition site of immune complexes IgA was strongly associated with24-hour urine protein.Conclusions:In the present cohort of crescentic IgA nephropathy it was confirmed that the four pathological parameters of Oxford Classification have strong relationship with the clinical indicators.The mesangial hyper-cellularity score, endocapillary hypercekkularity and tubular atrophy/interstitial fibrosis, as well as daily proteinuria have independent value in predicting renal outcome. The epidemiology and clinical features of the object of this study are basically consistent with the other literatures about the IgA nephrology.