Clinical And Pathological Features Of Thrombotic Microangiopathy Associated Nephropathy Described By Mono-centric Pathology

Objective:This paper analyzes the clinical manifestations and pathological features of 137 patients with thrombotic microangiopathy associated nephropathy retrospectively,and summarizes the relationship between the general pathogenesis,clinical and pathological features of patients with TMA disease caused by various diseases by mono-centric,which is helpful for providing basis for the diagnosis,differentiation of TMA disease-associated nephropathy.Methods:Collecting 137 cases of TMA related nephrosis in the nephrology department of the second hospital of Jilin University from January 2007 to December 2017.All the selected patients have complete records of their cases.Retrospectively analyzing clinical symptoms,sex,age,serum creatinine,serum albumin,24-hour urinary protein quantity,blood cells and pathological data of selected patients.Then analyzing the correlation among the characteristics,clinical symptoms and pathological features of the patients by using statistical method.Result:1.All statistics show that the diagnostic rate of TMA lesions has been increasing in the past 10 years.Among the 137 patients with TMA disease,55 are men and 82 are women,with a ratio of 1: 1.5,and there are more women patients than men patients;The onset age ranges from 18 to 44 years old,with an average age of 37.4±14.8 years.The majority of patients are young and middle-aged patients(67.9%).2.Clinical data shows that serum albumin,thrombocytopenia and anemia are more obvious in women than in men.In the patients with renal insufficiency,the impairment of renal function is more serious in men than in women.3.The types of diseases susceptible to TMA lesions are lupus nephritis(LN)(40.9%),malignant hypertension(21.9%),however,the incidence of Ig A nephropathy is 5.8%,and that of MPGN and SGN are 4.4% respectively,membranous nephropathy(MN),focal stage glomerulosclerosis(FSGS)and Mesangial proliferative glomerulonephritis(Ms PGN)are quite low.In each group,the onset age of MPGN is the oldest,and tend towards seniors;The body mass index of the MHT group is the highest,and overweight;The decrease of serum albumin in LN group is the most obvious,and renal insufficiency in MHT and TMA groups is the most serious.In LN group,the decreasing proportion of thrombocytopenia is(50.0%),the complement declining rate is 96.4 %,accounting the highest proportion,which is more typical than other groups.4.The pathogeny of TMA is complicated,LN and MHT the pathological results of TMA are consistent with the clinical diagnosis.Among the 26 patients with TMA,clinical initial diagnosis of MHT,hemolytic uremic syndrome(HUS)and NS are the most common,followed by LNs,and SSc is the least.5.The accumulation of thrombotic microangiopathy among all the seven groups is glomeruli,LN is the most obvious thrombus in loop cavity,accounting 76.8%,while the MHT group is less involved;Most of the basement membrane lesions are TMA(57.7%).Glomerular ischemia,sclerosis LN group is less(48.2%).The ratio of Ig AN,MPGN,LN and TMA is higher in patients with mesangial injury.Interlobular artery lesions is famous in TMA group(96.2%).The proportion of arteriolar endothelial damage in MHT group is the highest,and that in cellulose like necrosis Ig AN group is obvious;The intimal fibrous tissue proliferation is the highest in TMA group(30.8%),the small artery scallion skin changes in MHT group is the highest(86.7%),and the LN group is quite low(8.9%).Renal interstitial fibrosis is found in all 6 patients in MPGN group(100%),the lowest is Ig AN group(25%),acute tubular injury in Ig AN group is 25%,ratio for the remaining groups is quite low.Conclusion:1.The single center statistics show that the diagnostic rate of TMA lesions has been increasing in the past 10 years.2.In this study,TMA lesions are more common in young and middle-aged patients,with more women than men.3.In this study,SLE is the most common disease causing TMA lesions;Renal function damage in patients with MHT and HUS is quite serious;among which the renal function damage in male patients is more serious than that in female patients.4.This study shows that glomeruli are involved in all patients with TMA lesions.Glomeruli,arterioles and interstitium in TMA group are all seriously damaged;Microthrombus in laminin loop is more common in LN;The pathological feature of MHT is changing of arteriole scallion ski.