| Background:Primary Ig A nephropathy is a kind of primary glomerular disease which is characterized by deposition of Ig A or Ig A-based immunoglobulin in the glomerular mesangial area, and is also one of the important causes of end-stage renal diseases[1]. Although there is relatively large progress in the research aiming at the primary Ig A nephropathy, the etiology and pathogenesis of the Ig A nephropathy are not yet clearly explained. Although there are some classic treatment, the effective means are lacked. The clinical manifestations of the disease are diversified, the hematuria is the most common, while the proteinuria as the main is rare. Currently, the studies on the Ig A nephropathy with proteinuria as the main are less. Objective:To analyze the clinical and pathological features of Ig A-nephropathy patients with proteinuria as the main and correlation between the two features to provide the basis for diagnosis and treatment of the disease and to determine the factors affecting prognosis. Methods:A retrospective study was conducted on the clinical and pathological data and the relationship between the two of 112 cases of inpatients who were confirmly diagnosed as Ig A nephropathy by renal biopsy with urine routine examination revealing red blood cells<5/HPF and qualitatively positive urine protein at our hospital from January 2002 to October 2015. The clinical data includes patient age, gender, ethnicity, predisposing factors, blood pressure,24-hour urinary protein quantitation, triglycerides, total cholesterol, serum creatinine, uric acid, etc. The pathological data includes pathological grading, and immunity complex deposition strength and type. According to the age, Lee’s grading, clinical manifestations, etc. of Ig A nephropathy patients with proteinuria as the main, the patients were grouped. The clinical characters, blood pressure, kidney function, urine protein level, uric acid and blood lipids of patients with different age and gender were observed. The clinical and pathological characteristics of Ig A nephropathy patients with proteinuria as the main, and the relationships between the clinical and pathological and laboratory parameters were analyzed. Measurement data were expressed as mean ± standard deviation. Count data were expressed as percentage and/or ratio and analyzed by chi-square test. The comparisons of the measurement data among multiple groups were subjected to analysis of variance. A P<0.05 was considered as statistically significant difference and a P<0.01 as extremely statistically significant difference. Results:1. Clinical data analysis of 112 cases of Ig A nephropathy patients with proteinuria as the main:(1) General information: There were 67 cases of males and 45 cases of females. The number of male patients was significantly more than that of female patients(P<0.05). There were no significant differences in each age period of disease onset of both genders. The ratio of male to female was 1.49 : 1. The age of patients conducting biopsy was 16 to 71 years with a mean age of 40.77 ± 17.02 years. The disease onset cases were the most in the youth group and showed extremely significant differences among all age groups(all P<0.01).(2) Predisposing factors: There were 95 cases with no obvious predisposing factors, which was significant more than the other two groups with predisposing factors(both P<0.01). In the two groups with predisposing factors, the number of patients with upper respiratory tract infection was significantly more than that of patients with fatigue onset(P<0.01).2. Pathological data analysis of 112 cases of Ig A nephropathy patients with proteinuria as the main:(1) The Lee’s grading of 112 cases of Ig A nephropathy with proteinuria as the main was mostly in grade III. The gender had no obvious effects on the Lee’s grading distribution of Ig A nephropathy with proteinuria as the main. Grade III and IV were common to young patients(both P<0.05).(2) Antibody complex deposition was mostly Ig A(P<0.05). Immunofluorescence intensity of Ig A deposition was mostly ++(P<0.01). C3 deposition was a mostly common complement complex deposition(P<0.05). There were no correlations between antibody complex deposition type, Ig A deposition immunofluorescence intensity, complement complex deposition type and Lee’s grading.3. Laboratory examination results of 112 cases of Ig A nephropathy patients with proteinuria as the main:(1) The normal renal function people in Ig A nephropathy patients with proteinuria as the main were significantly more than people with renal dysfunction(P<0.01). In patients with renal dysfunction, the male patients were significantly more than female patients(P<0.01). The renal function was significantly not related with ages. The blood pressures of Ig A nephropathy patients with proteinuria as the main were mostly normal(P<0.05). The patients with hypertension were mostly young people(P<0.05). The blood pressure was unrelated to gender. A large amount of proteinuria was rare in Ig A nephropathy patients with proteinuria as the main. Besides, the degree of proteinuria was not associated with both gender and age.(2) As the Lee’s grading level increased, the patients with hypertension and renal insufficient clinical manifestations gradually increased. But the Lee’s grading level was not correlated with the degree of proteinuria, suggesting that the degree of proteinuria can not fully reflect the situation of kidney damage.(3) The people with normal uric acid level in the Ig A nephropathy patients with proteinuria as the main were significantly higher than people with hyperuricemia(P<0.01). In people with hyperuricemia, the male patients were more than the female patients(P<0.05). The company of hyperuricemia was not related to age. The people with hyperlipidemia in Ig A nephropathy patients with proteinuria as the main were obviously higher than people with normal blood lipids(P<0.01). The company of hyperlipidemia was not associated with gender and age. People with hyperuricemia were more than people with hyperlipidemia(P<0.01). With the degree of proteinuria gradually increasing, the patients with hyperlipidemia gradually decreased(P<0.05). Conclusion:1. Ig A nephropathy patients with proteinuria as the main were mostly common in young people; the male patients were more than the female patients. The disease onset was concealed without obvious predisposing factors.2. The Lee’s grading of Ig A nephropathy patients with proteinuria as the main was mainly grade III. Ig A deposition fluorescence intensity was not related with extent of pathological damage and the severity of illness state.3. With the increase of Lee’s grading level in Ig A nephropathy patients with proteinuria as the main, the accompany of hypertension and renal insufficiency cases of clinical manifestations gradually increased.4. The degree of proteinuria in Ig A nephropathy patients with proteinuria as the main can not fully reflect the degree of renal impairment.5. No matter what degree of the proteinuria is in Ig A nephropathy patients with proteinuria as the main, renal biopsy should be conducted to clarify pathological changes and targeted diagnosis and treatment should be taken to delay the progression of renal insufficiency. |
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