| Background: IgA nephropathy,was first proposed in 1968 and named by the French scholar Berger,which is a glomerular disease,Refers to the mesangial region IgA or immunoglobulin IgA deposition mainly diffuse deposition of particulate distribution lumps or dispersed,it may be associated with the deposition C3,C1 q,but also may be associated with IgM,IgG deposition[1].As the most common childhood primary glomerular disease,IgAN is a chronic progressive disease,the major clinical manifestations of recurrent gross hematuria or microscopic hematuria,infection increased,may be associated with varying degrees of renal dysfunction,hypertension and proteinuria.Although self-discovery has been nearly 50 years,but people are still not enough awareness of IgAN comprehensive study of early people it as a better prognosis of benign disease,but recent studies have shown that,IgAN patients after 10 years,and 20 years later the development of end-stage renal failure（end-stage renal failure,ESRF）ratios were 15% to 20% and 30% to 40% [2],we can see,IgAN has become a serious health hazard for children of important diseases,It is one of the important causes of ESRF.For the pathogenesis of IgAN observed clinical and pathological study focused on the immune response,genetic,inflammatory mediators,ethnic and other aspects of infection,but due to its mechanism is very complex,there is still no unified conclusion.On the other hand,there is no simple diagnostic for IgAN specific examination methods,mainly based on kidney biopsy invasive method of operation,mesangial immunoglobulin deposition pathological diagnosis by immunofluorescence show,in addition to pathological changes its treatment and prognosis has important guiding role.Among them,the renal biopsy performance complexity and diversity,mainly for minor lesions,mild mesangial lesions,segmental glomerular sclerosis,global sclerosis,tubular atrophy,interstitial fibrosis and inflammatory cell infiltration,covering almost all the different levels of primary glomerular lesions.Meanwhile,pathological changes and clinical manifestations has some incomplete consistency,mainly with a clear asymmetry in the clinical manifestations and severity of kidney disease in children,it can not simply be judged by its clinical manifestations of renal lesions.Thus,the diversity of the clinical and pathological damage,the complexity and inconsistency of clinical diagnosis and prognosis of IgAN is estimated to have increased some difficulty.In the treatment method,the complex and diverse clinical manifestations of IgAN large pathological type and extent of the damage glomerular differences currently the world there is no uniform effective treatment,mainly symptomatic treatment to take measures that,according to the patient clinical manifestations and laboratory test results for different degrees of clinical symptoms and signs to select symptomatic treatment,such as reducing proteinuria,control of hypertension,correct urinary occult blood,improve graft survival and delay disease progression.Thus,a positive response IgAN,early diagnosis,treatment depending on the clinical manifestations and pathological changes,has become the consensus of pediatric nephrology physicians,in order to improve the prognosis of children to the maximum extent,reduce the financial burden and psychological pressure on families of children.Objective: This study was to investigate the clinical manifestations in children with primary IgAN（age,gender,disease duration,hematuria）,laboratory tests（24h urinary protein,serum creatinine,blood urea nitrogen,triglyceride,total cholesterol）and pathological features（mesangial cell proliferation,endothelial cell proliferation,adhesion or segmental sclerosis,tubular atrophy and interstitial fibrosis,monocytes and lymphocytes）,summarized its relevance,clinical treatment and prognosis is provided in accordance with.Methods:The clinical features,clinical types,pathology classification and immunological changes and their mutual relationships of 182 children with IgAN confirmed by renal biopsy were analyzed retrospectively,who were admitted in The Second Hospital of Hebei Medical University pediatric kidney group from 2003-2015.Results: 1 From April 2003 to September 2015,182 hospitalized children were diagnosed as IgAN by kidney—puncture,more common in male,the male to female ratio ratio was = 2.08: 1,age at the disease diagnosis was 9.80 ± 2.26 years;2 Children onset 67.0% have incentives,including respiratory infection that mainly gastrointestinal infections followed;3 Clinical manifestations of gross hematuria（with or without swelling）were the most common chief complaint of a total 107 cases（58.8%）.Clinical classification to nephrotic syndrome is the most common 76 cases（41.8%）,followed by hematuria and proteinuria 57 cases（31.3%）;4 Subclass III（45.6%）are the most common histologic type.The main type of immune-complex deposition is IgA+IgM（C3）;5 There is significant distinction of pathological lesion distr-ibution in different clinical type.There is also significant distinction of pathological lesion distribution in different immune complex deposition.There is a correlation between immune complexes in IgA and C3 deposition.There is a correlation between tublar interstitial lesion and renal tubular function;6 Proteinuria is the independent risk facter for the prognsis of IgA nephropathy through logistic regression analysis of risk factors.Conclusion:1 The patients of boys are far more than girls（2.08:1）.2 The type of nephrotic syndrome is the most common clinicalmanifestation.3 Subclass III are the most common histologic type.The main type of immune—complex deposition is IgA+IgM（C3）.The degree of IgA deposition increases,the degree of complement component 3 deposition increases.There is significant distinction of pathological lesion distribution in different clinical type.There is also significant distinction of pathological lesion distribution in different immune complex deposition.There is a correlation between immune complexes in IgA and C3 deposition.There is a correlation between tublar interstitial lesion and renal tubular function.4 Proteinuria is the independent risk facter for the prognsis of IgA nephropathy through logistic regression analysis of risk factors. |
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