| BackgroundIgA nephropathy is one of the most common-seen primary glomerulonephritis worldwidely, accounting for30-50%of the overall primary glomerulonephritis in China. According to its clinical manifestation, it can be divided into several types:isolated microscopic hematuria type, massive proteinuria type, chronic renal failure type, crescrentic type, combined with acute renal failure type.Lots of studies have found that,24-hour urinary protein quantity more than1g/d, high level of creatinine, severe pathological lesions (such as glomerular sclerosis, renal interstitial fibrosis, renal tubular atrophy and so on) are the risk factors of IgAN for poor prognosis. In the past, it was thought that patients with isolated hematuria had mild pathological lesions with a favorable prognosis, needn’t conduct renal puncture or receive special treatment. So in the clinic, doctors and patients don’t attach importance to IgAN patients with isolated hematuria. And renal biopsy is not recommednded. However, recent studies have shown that patients with mild clinical manifestation may have relatively severe pathological lesions, such as glomerular sclerosis, renal interstitial fibrosis, renal tubular atrophy and so on.Some experts don’t suggest any special treatment for patients with isolated hematuria. Some experts treat patients with ACEI/ARB with a poor clinical effect. Besides, western medicine has some side effect.TCM has some advantages in treating IgAN, especially in improving patients’clinical symptoms. In the past, studies reported the etiology, pathogenesis, and the treatment based on syndrome differentiation of IgAN as a whole, without considering the different manifestation types. The author thinks that IgAN patients with isolated hematuria are different from other manifestation types in etiology, pathogenesis, and the treatment based on syndrome differentiation.Apparently, there are few studies conducted on the clinical features, renal pathology and and traditional Chinese medicine (TCM) syndrome of IgAN with isolated hematuria. While the studies on the correlation between the hematuria degree and clinical indexes, renal pathology, syndrome differentiation of traditional Chinese medicine are fewer.This study collects67biopsy-proven IgAN cases (from May2008to December2013) manifested with isolated hematuria and/or mild proteinuria, analyse the clinical indexes, renal pathology and TCM syndrome. Then explore the correlation between the hematuria and clinical indexes, renal pathology, syndrome differentiation of TCM in order to supply some evidence in formulating renal puncture indication, guiding integrative therapy of TCM and western medicine.ObjectiveTo explore the correlation between the hematuria degree and clinical indexes, renal pathology, syndrome differentiation of traditional Chinese medicine (TCM) in the patients of IgA nephropathy manifested with isolated hematuria.MethodsClinical and pathological data from67biopsy-proven IgAN cases (from May2008to December2013) manifested with isolated hematuria were studied retrospectively. Study the features of clinical indexes, pathology and syndrome differentiation of TCM, then analysis the correlation between the hematuria degree and clinical indexes, renal pathology, syndrome differentiation of traditional Chinese medicine.Results1. Basic materialsThere were221biopsy-proven IgAN cases from Guang’an men Hospital (from May2008to December2013).67cases were selected according to inclusion criteria.30.3%of the overall IgAN cases were manifested with isolated hematuria. The ratio of male/female was1:1.48. The average age of renal puncture was34.99±9.31, while the average age of onset was32.91±9.79.68.7%of patients were aged between21to40. There was no statistical significance between sex in the onset age (P>0.05). The mean duration of disease was6months (from1day to30years).82.1%patients were to conduct renal puncture within2years of onset.26cases (38.8%) were reported with preceding infection within1months of renal puncture. The most common infection was upper respiratory tract infection, accounting for19cases (73.1%). Gastrointestinal infection accounted for15.4%(4cases), urinary tract infection7.7%(2cases), pulmonary infection3.8%(1case).29.9%were reported with gross hematuria during disease course.2. The correlation between hematuria and clinical indexes2.1The correlation between hematuria and24-hour urine protein quantitationThere were33cases (49.3%) whose urinary RBC counted between3/HP-10/HP,10/HP～20/HP accounting for23.9%(16cases),>20/HP accounting for26.9%(18cases). The average24hour-urine-protein-quantitation of67cases was0.54±0.27g/d.34cases (50.75%) were presented with urine protein quantitation≤0.5g/d, while33cases (49.25%) were with urine protein quantitation>0.5g/d. The level of urine protein quantitation was increasing along the increase of urinary RBC count (P<0.05) 2.2The correlation between hematuria and renal fuctionAmong the67cases, the percentage of CKD1,2,3stage were61.2%,29.9%and9.0%respectively. There was no statistical significance among the hematuria degrees in CKD stage distribution (P>0.05)2.3The correlation between hematuria and other clinical indexesThere was a positive correlation between hematuria and onset age(P<0.05). There were no correlation between hematuria and course of disease, serum creatinine, serum albumin, uric acid, hemoglobin, serum IgA, total cholesterol, triglyceride(P>0.05).3. The correlation between hematuria and renal pathology3.1The correlation between hematuria and pathological typesAs for the renal pathological types, the focal proliferative type was the most common-seen type, accounting for71.6%, then the mild mesangial proliferative type. There was no significance among the degrees of hematuria in pathological type distribution (P>0.05). The incidence of proliferative-sclerous type, focal proliferative-necrotic type was lower in the patients with a gross hematuria experience than the patients with no gross hematuria experience (P<0.05)3.2The correlation between hematuria and renal pathological changesAmong67patients,37.3%of patients were reported with glomerular sclerosis, segmental sclerosis22.4%, cellular or fibrous crescent formation20.3%, segmental fibrinoid necrosis6.0%. There was no statistical significance among the degrees of hematuria in the incidence of glomerular sclerosis or crescent formation (P>0.05)3.3The correlation between hematuria and the IgAN Oxford ClassificationAs for the Oxford classification of the67cases, M1E0S0T1was the most common seen type, accounting for52.2%. The incidence of M1, E1, S1, T1/T2were100%,4.5%,2.2%and86.5%respectively. There was no statistical significance among the degrees of hematuria in the incidence of M, E, S, T (P>0.05)4. The correlation between hematuria and syndrome differentiation of TCMAmong the67cases,20cases were in acute stage, and the wind-heat evil syndrome was seen more (20.9%). As for the chronic persistent stage, Qi and Yin deficiency type was common seen (34.3%), while Qi deficiency of lung and spleen was the least syndrome (6.0%). There was no statistical significance between wind-heat evil syndrome and damp-heat in lower jiao syndrome in serum creatinine,24-hour-urine-protein-quantitation, eGFR, urinary RBC count in high power field (P>0.05). There was no statistical significance among Qi deficiency of lung and spleen, Qi and Yin deficiency, Yin deficiency of liver and kidney, Yang deficiency of spleen and kidney in serum creatinine and eGFR (P>0.05). As for the24-hour-urine-protein-quantitation, Yang deficiency of spleen and kidney> Qi and Yin deficiency> Yin deficiency of liver and kidney>Qi deficiency of lung and spleen (P<0.05).As for the urinary RBC count, Yang deficiency of spleen and kidney>Qi and Yin deficiency> Yin deficiency of liver and kidney> Qi deficiency of lung and spleen (P<0.05). There was no statistical significance between acute stage and chronic persistent stage in serum creatinine,24-hour-urine-protein-quantitation, eGFR, urinary RBC count in high power field (P>0.05).Conclusions1. In the patients of IgA nephropathy manifested with isolated hematuria, there was a positive correlation between hematuria degree and urine protein quantitation. There was no obvious correlation between the hematuria degree and renal pathology.2. For the patients of IgA nephropathy manifested with isolated hematuria, Qi and Yin deficiency was the most common syndrome differentiation, while Qi deficiency of lung and spleen was the least seen type. The distribution of syndrome types was in accord with the overall IgAN patients.3. For the patients of IgA nephropathy manifested with isolated hematuria, the degree of hematuria and urine protein quantitation was the worst in Yang deficiency of spleen and kidney. |
