The Associations Of Serum Lipids And Homocysteine With The Clinicopathological Indices In Patients With IgA Nephropathy

Objective:To observe the effects of different serum lipids and serum homocysteine levels with the clinicopathological indices in Patients with IgA nephropathy.Methods:A cross-sectional study was carry out. Three hundred and one Patients with IgA nephropathy diagnosed by renal biopsy were classified into the following groups:hypercholesteremia group and non-hypercholesteremia group; hypertriglyceridemia group and non-hypertriglyceridemia group; hyperhomocysteinemia group and non-hyperhomocysteinemia group; compared the clinical and Pathological data in each two groups, at the same time analysis the association of the serum lipid and serum homocysteine with the clinical indicators (body mass index, blood Pressure, serum urea nitrogen, serum creatinine, serum uric acid, hemoglobin, serum albumin,24 hours urinary Protein, serum 25-hydroxyvitam D3) and Pathological indicators (Glomerular sclerosis Percent, crescent Percent, mesangial cell hyperplasia degree, endothelial cell hyperplasia degree, segmental sclerosis degree, renal tubular atrophy/fibrosis degree).Results:(1)There were 301 Patients enrolled in the study, with the male to female ratio of 3:4. And the largest proportion of IgA nephropathy Patients was aged btween 20 to 40 years old.35.88% of IgA nephropathy Patients with hypercholesteremia,36.54% of IgA nephropathy Patients with hypertriglyceridemia.85.4% 85.4% of IgA nephropathy Patients with hyperhomocysteinemia.(2)In the Patients with IgA nephropathy, hypercholesteremia group with the higher diastolic blood Pressure,, more 24h urine Protein levels (P< 0.05); and lower Serum albumin levels than the non-hypercholesteremia group(P< 0.05). The Glomerular sclerosis Percent, crescent Percent, mesangial cell hyperplasia degree, endothelial cell hyperplasia degree, segmental sclerosis degree, renal tubular atrophy/fibrosis degree had no statistical difference between the two groups.(3) hypertriglyceridemia group with elder age, higher BMI, higher systolic Pressure, higher diastolic blood Pressure, higher serum uric acid, higher 24 hours urinary Protein (P< 0.05), and lower eGFR, lower serum total Protein, lower serum albumin (P<0.05). On the Pathological aspects, hypertriglyceridemia group with the more serious Glomerular sclerosis segmental sclerosis degree and renal tubular atrophy/fibrosis (P< 0.05).(4) In the Patients with IgA nephropathy,hyperhomocysteinemia group with the higher serum urea nitrogen, higher serum creatinine, higher serum uric acid and lower eGFR than non-hyperhomocysteinemia group (P<0.05); On Pathological aspects, hyperhomocysteinemia group with the more serious Glomerular sclerosis and renal tubular atrophy/fibrosis (P<0.05).(5) In the Patients with IgA nephropathy, serum triglyceride level was increase with the CKD1 stage to the CKD3 stage, but decline from CKD3 stage to the CKD5 stage. And the highest serum triglyceride level was at the CKD3 stage.The serum triglyceride levels was statistically significant between CKD3 stage And CKD5 stage(P< 0.05). The serum homocysteinemia level was increase from the CKD stage 1 to 5(P< 0.05).(6) Single factor correlation analysis of serum lipid and homocysteine with the clinicopathological indices in IgA nephropathy Patients:① the serum cholesterol, serum triglycerides, and serum low density lipoprotein cholesterol were Positively correlated with the blood Pressure and urine Protein, and negatively correlated with the serum albumin, hemoglobin (P<0.05); But moreover, Serum triglycerides were Positively correlated with age, weight, quality index, blood uric acid, glomerular sclerosis, renal tubular atrophy/interstitial fibrosis (P< 0.05), and negatively correlated with eGFR (P< 0.05). ②The serum high density lipoprotein were Positively correlated with eGFR (P<0.05), and negatively correlated with the weight of quality index, blood Pressure, serum uric acid, glomerular sclerosis, renal tubular atrophy/fibrosis (P<0.05). ③apolipoprotein B, lipoprotein(a), apolipoprotein AI were Positively correlated with 24 hours urinary Protein (P<0.05), apolipoprotein B, lipoprotein a were negatively correlated with serum albumin (P<0.05),.and the three ot them with no statistical significance correlation with renal Pathological index.④serum homocysteine were Positively correlated with the weight mass index, blood Pressure, blood urea nitrogen, serum creatinine, serum uric acid, serum (inhibition, glomerular sclerosis, renal tubular atrophy/C fibrosis (P<0.05), and negatively correlated with the eGFR, hemoglobin (P<0.05).(7) multiple linear regression analysis:serum Homocysteine level, renal tubular atrophy/interstitial fibrosis and age were independent risk factors for eGFR decline; hemoglobin was the independent Protection factor for eGFR decline.(8)IgA nephropathy Patients with hyperhomocysteinemia and hypercholesteremia at the same time always with the younger age, lower serum albumin, more urine Protein (P<0.05); IgA nephropathy Patients with hyperhomocysteinemia and hypertriglyceridemia at the same time always with the higher blood Pressure, higher serum urea nitrogen, higher serum creatinine, higher serum uric acid, more urine Protein, and the lower eGFR, and more serious glomerular sclerosis and renal tubular atrophy/fibrosis (P<0.05);IgA nephropathy Patients with hyperhomocysteinemia and low high-density lipoprotein cholesterol at the same time always with the elder age, higher blood Pressure,higher serum creatinine, higher serum uric acid(P< 0.05);Conclusion:1.It’s common with hyperhomocysteinemia in Patients with IgA nephropathy;2.IgA nephropathy Patients with the hyperlipidemia (and/or) hyperhomocysteinemia not always accompany with the more serious clinical and renal Pathological damage than the non-hyperlipidemia (and/or) non-hyperhomocysteinemia Patients; 3.High serum triglycerides and high homocysteine levels were closely related to the renal tubular atrophy/interstitial fibrosis.4.hyperhomocysteinemia was independent risk factors for kidney function decline.