Comparative Studies Between The Complement And Immunoglobulin Of Primary Nephrotic Syndrome And Clinical Pathology

Objectives To investigate the correlation between immunity index and clinicalpathology in the patients with primary nephrotic syndrome, so as to provide conductiveopinions for pathological diagnosis.Methods We analyze retrospectively91patients from the nephrology department ofthe Affiliated Hospital of Yan’an University who had been proved to be primarynephrotic syndrome by renal biopsy during the period from2011.12to2012.12.According to the correlation of91PNS patients with clinical pathology andC3,C4and immunoglobulin IgG, IgA,IgM,IgE, the groups were separated bygender,age,24h urine protein quantitative level,plasma albumin levels, kidneypathological type,kidney immune deposits,degree of tubulointerstitial injuries and so on.The correlation of immunoglobulin and clinical pathology was analyzed by statisticalanalysis.Results1. The general situation of PNS patientsMesangial proliferative glomerulonephritis was the most frequent pathologic type(36cases,39.6%) of PNS in northern part of Shanxi Province,followed by membranousnephropathy（28cases,30.8%）, minimal change disease （12cases,13.2%）,IgAnephropathy（5cases,5.5%），Focal segmental glomerulosclerosis（8cases,8.8%），endocapillary proliferative glomerulonephritis（1case,1.1%），membranoproliferativeglomerulonephritis（1case,1.1%）.2. The comparison between complement, immunoglobulin and general information There are also interesting breakdowns by gender, and so if we look at the males andthe females of primary nephrotic syndrome, you see that the females had a higher level ofIgG and IgM（P＜0.05）, on the contrary, the males had a higher level of IgE（P＜0.05），however,IgA,C3and C4had no statistical significance between the sexes（P＞0.05）.IgG in the group with age older than50was obviously higher than those in othergroups with different ages（P＜0.05）, IgE in the group with age less than20wasobviously higher than those in other groups with different age（sP＜0.05）, however, IgA,IgM, C3and C4had no statistical significance among the groups with age（P＞0.05）.3. The comparison between between complement,immunoglobulin and clinical dataIgA in the group with urine protein higher than5.0g/d was obviously higher thanthose in other groups with different levels（P＜0.05）, however, IgG, IgM, IgE, C3andC4had no statistical significance among the groups（P＞0.05）.IgA had significantpositive correlation with24h urine protein(r=0.228，P=0.030＜0.05). Significance testswere made on linear regression relationship between IgA and24h urine protein, and theprobability of regression coefficient was P=0.013＜0.05.IgG in the group with albuminless than20g/L was obviously lower than those in other groups with different levels（P＜0.05）, however, IgA, IgM, IgE, C3and C4had no statistical significance among thegroups（P＞0.05）.4.The comparison between complement,immunoglobulin and renal pathology typeThe deposit of IgM in kidney tissues accounted for70cases (76.92%) of the totalrenal patients biopsied, secondary IgG73.63%，C342cases (46.15%)，and IgA26cases(28.57%).The rate of immunoglobulin and complement had a significant difference (2=57.990，P＜0.001))，and the differences of immunofluorescence were statisticallysignificant （P＜0.05）. The deposit of IgG and C3in kidney tissues of membranousnephropathy was higher than those in other groups with different pathological patterns（P＜0.05），the deposit of IgA in kidney tissues of IgA nephropathy and Focal segmentalglomerulosclerosis membranous nephropathy was higher than those in other groups withdifferent pathological patterns（P＜0.05），and the deposit of IgM in kidney tissues of Mesangial proliferative glomerulonephritis was higher than those in other groups withdifferent pathological patterns（P＜0.05）.The deposit of immune substances in kidneytissues took no direct relationship with complement and immunoglobulin in serum（P＞0.05）.IgM, IgE and C3had statistical significance among the groups with pathologicalpatterns（P＜0.05）.IgE and C3in the groups with pathological pattern of FSGS wasobviously lower than the other groups （P＜0.05），however,IgG,IgA and C4had nostatistical significance among the groups（P＞0.05）. IgA in the group with IgAN had nostatistical significance among the groups（P＞0.05）.IgE in the group with severity scorewhich was0of tubulointerstitial injuries was obviously higher than that group with1～4（P＜0.05）.Conclusions1.In the high level IgE of the male group,the tubulointerstitial injuries of maleswhich were young patients may be lower, their therapy seemed to be more effective andprognosis seemed to be more excellent. IgG in the group with age older than50wasobviously higher than those in other groups with different ages.2.In this study,the higher blood levels of IgA, there may be higher level of24h urineprotein.We should give prophylactic anticoagulation to the group with low level IgG andplasma albumin as early as possible because of high coagulation state in the patients.3.The rate of immunoglobulin and complement had a significant difference，and thedifferences of immunofluorescence were statistically significant. The pathologicalpattern with lower serum IgE and C3levels may be FSGS.