| ObjectiveTo compare and analyze the clinical characterictis, pathology and prognostics of IgA nephropathy in adults with nephrotic syndrome, and to explore the relationship between urinary protein in IgA nephropathy with nephrotic syndrome and the foot cell injury.MethodsThe basic information of patients with IgA nephropathy diagnosed by renal biopsy in the First Affiliated Hospital of Zhengzhou University during 2012-2015 was retrospectively analyzed. Exclusion criteria:patients who didn’t live in Henan; non-adult patients; patients with secondary nephropathy; patients with diabetes mellitus, renal interstitial lesions of myeloma; patients who received corticosteroids, immunosuppressive therapy before renal biopsy; patients whose clinical data were incomplete. Another 1568 patients who met the criteria of IgA nephropathy were selected and divided into nephrotic syndrome group (495 cases) and non-nephrotic syndrome group (1073 cases) according to whether they were nephrotic syndrome type. The gender, age,24 h urinary protein excretion (24 hUPE), serum albumin (ALB), hemoglobin(HGB), serum total protein (TP), serum creatinine (Scr), blood urea nitrogen (BUN), glomerular filtration rate (GFR), blood uric acid (BUA), mean arterial blood pressure (MAP), triglycerides (TG), total cholesterol (TC), immune complex deposition, clinical manifestation, pathological type, pathological classification, treatment and prognosis of patients in two groups were compared, and according to the electron microscope, the results were analyzed with the presence of foot cell injury and the degree of injury of the foot cells.Results1 A total of 13961 patients underwent renal biopsy. Among these patients,3574 (25.6%) cases with IgA nephropathy were detected, male 2147 cases, female 1427 cases, male to female ratio was 1.50/1; nephrotic syndrome 938 cases (26.25%), asymptomatic abnormal urine type 903 cases (25.27%), nephritic syndrome 1151 cases (32.20%), chronic glomerulonephritis 332 cases (9.29%) renal failure 306 cases (8.56%), the other 297 cases (8.31%).2 In the nephrotic syndrome group, male 296 cases, female 199 cases, male to female ratio was 1.49:1; in the non-nephrotic syndrome group,644 male cases,4296 female cases, male to female ratio was 1.50:1, and there was no significant difference between the two groups (χ~2=0.007, P=0.934).3 Patients with nephrotic syndrome of IgA nephropathy for young patients with non nephrotic syndrome IgA nephropathy in young (age 18-30 years old), middle-aged (age 31-50 years old), the elderly (age>50 years old) of all ages are uniformly distributed, two had obvious difference (χ~2=57.086, P<0.001).4 Compared with the non-nephrotic syndrome group,24 h UPE significantly increased, TP and ALB significantly decreased in the nephrotic syndrome group (P<0.001).5 Compared with the non-nephrotic syndrome group, Scr, BUN, GFR, BUA, MAP, TC and TG significantly increased in the nephrotic syndrome group (P<0.001).6 The majority of immune complex deposition types in patients with nephrotic syndrome type IgA nephropathy and patients with non-nephrotic syndrome type IgA nephropathy both were IgA, C3 co-deposition, IgA, IgM, C3 co-deposition and IgA deposition, but the immune complex deposition types of two groups had significant difference (χ~2=18.031, P<0.01).7 Most patients with nephrotic syndrome type IgA nephropathy showed edema and hematuria+proteinuria, while most patients with non-nephrotic syndrome type IgA nephropathy showed simple hematuria or simple proteinuria, and the two had significant difference (P<0.001).8 The majority types of pathological classification in nephrotic syndrome group were moderate mesangial proliferative IgA nephropathy, focal proliferative IgA nephropathy and mild mesangial proliferative IgA nephropathy in turn, the majority types of pathological classification in non-nephrotic syndrome group were mild mesangial proliferative IgA nephropathy, focal proliferative IgA nephropathy and moderate mesangial proliferative IgA nephropathy in turn, and the two had significant difference (χ~2=30.255, P<0.001).9 The electron microscope of the nephrotic syndrome group was characterized by extensive fusion of foot process, and the electron microscope of the non-nephrotic syndrome group was characterized by focal fusion of foot process, and the two had significant difference (χ~2=306.653, P<0.001).10 The pathological grading of most patients with nephrotic syndrome type IgA nephropathy were grade Ⅲ and grade Ⅳ, grade Ⅲ and above accounted for 70.71%; the pathological grading of most patients with non-nephrotic syndrome type IgA nephropathy were grade Ⅰ, grade Ⅱ and grade Ⅲ, grade Ⅲ and above accounted for 49.48%. The degree of renal pathological changes in patients with nephrotic syndrome type IgA nephropathy were more serious than it in patients with non-nephrotic syndrome type IgA nephropathy, and the two had significant difference (χ~2=77.402, P<0.001).11 In the nephrotic syndrome group,313 cases (63.23%) were treated with hormone therapy,51 cases (10.30%) were treated with hormone+immunosuppressive therapy,131 cases (26.46%) were treated with other therapy; in the non-nephrotic syndrome group,473 cases (44.08%) were treated with hormone therapy,86 cases (8.01%) were treated with hormone+immunosuppressive therapy,514 cases (47.90%) with treated with other therapy, and the two had significant difference (χ~2=64.659, P<0.001).12 After 6 months of treatment, in the nephrotic syndrome group,50 cases were lost to follow up and loss rate was 10.10%,93 (20.90%) patients were complete remssion,127 (28.54%) patients were effective remission,197 (44.27%) patients were partial remission, and 28 (6.29%) patients were ineffective; in the non-nephrotic syndrome group,120 cases were lost to follow up and loss rate was 11.18%,272 (28.54%) patients were complete remssion,324 (34.00%) patients were effective remission,209 (32.42%) patients were partial remission, and 48 (5.04%) patients were ineffective, and the two had significant difference (χ~2=22.228, P<0.001).After 1 year of treatment, in the nephrotic syndrome group,92 cases were lost to follow up and loss rate was 18.59%,106 (26.30%) patients were complete remssion, 132 (32.75%) patients were effective remission,145 (35.98%) patients were partial remission, and 20 (4.96%) patients were ineffective; in the non-nephrotic syndrome group,187 cases were lost to follow up and loss rate was 17.43%,264 (29.80%) patients were complete remssion,332 (37.47%) patients were effective remission, 258 (29.12%) patients were partial remission, and 32 (3.61%) patients were ineffective, and the two had significant difference (χ~2=8.314, P=0.040).Conclusion1 In Henan region, IgA nephropathy accounted for 25.6%of renal biopsy, the ratio of male to female was 1.50/1, and the nephritis syndrome was the most important clinical classification.2 The ratio of male to female was 1.49:1 in nephrotic syndrome type IgA nephropathy,1.50:1 in non-nephrotic syndrome type IgA nephropathy, and the two had significant difference.3 The age distributions between patients with nephrotic syndrome type IgA nephropathy and patients with non-nephrotic syndrome type IgA nephropathy were significantly different.4 Compared with the non-nephrotic syndrome type IgA nephropathy, the proteinuria, hypoproteinemia, injury of renal function and abnormality of blood uric acid, blood pressure and blood lipid were more serious in patients with nephrotic syndrome type IgA nephropathy.5 The immune complex deposition type, clinical manifestation, pathological type, histological grade and treatment were not the same between patients with nephrotic syndrome type IgA nephropathy and patients with non-nephrotic syndrome type IgA nephropathy. The injury of kidney podocyte in syndrome group was more serious than it in non-syndrome group. The remission rates after treating for six months or one year in syndrome group were low than these in non-syndrome group. |
