| Objective: To investigate the difference of uric acid levels and related factors among different pathological types of primary glomerular diseases.And promote people’s acknowledge and attention to uric acid level in patients with primary glomerular disease.Methods: 158 patients with primary kidney disease(e GFR > 60 ml/min.1.73m2)that hospitalized in the nephrology department of our hospital with complete clinical data form 2013 to 2018 and of whom the primary kidney diseases were diagnosed by renal biopsy were selected.Exclusion criteria: 1.None of the selected patients were affected by diabetes mellitus,allergic purpura,hepatitis B,systemic lupus erythematosus,or Secondary glomerular disease such as ANCA-associated vasculitis and gout.2.Because of the small number of samples,pathological types other than Ig A nephropathy,minimal change,membranous nephropathy,FSGS were excluded.Biochemical indicators of sex,age and blood were collected: 24 h urinary protein quantification,hemoglobin,serum creatinine,serum uric acid,triglyceride,total cholesterol,high density lipoprotein,low density lipoprotein,et.al.Ig A nephropathy Oxford classification according to the results of M,E,S,T.The data is analyzed and processed by SPSS23.0 statistical analysis software.SPSS23.0 statistical analysis software was used to analyze and process the data.The difference was regarded as significant when P < 0.05.Results:1.There were significant differences in e GFR,lipid index and 24 h urinary protein levels among Ig A nephropathy,minimal change,membranous nephropathy and FSGS(P < 0.05).No significant difference in serum uric acid(P > 0.05).2.Influencing factors of uric acid in primary glomerular disease: Uric acid in all patients was correlated with gender,age,uric acid and blood lipid,renal function and24 h urinary protein quantitative(P < 0.05).To further eliminate the effect of abnormal renal function on uric acid,all patients were divided into normal renal function group and abnormal renal function group according to e GFR > 90 ml/min.1.73 m2.The results showed that the level of serum uric acid in abnormal renal function group was higher than that in normal renal function group;The levels of serum uric acid in normal renal function group was correlated with e GFR and 24 h urinary protein quantitative(P < 0.05);And the level of serum uric acid in abnormal renal function group was not correlated with 24 h urinary protein quantitative and e GFR(P > 0.05).It suggests that the elevated uric acid levels in primary glomerularnephritis patients with renal dysfunction may not be caused by e GFR decline.All patients were divided into groups of > 40 years old and ≤ 40 years old.The results showed that the level of serum uric acid in > 40 years old group was higher than that in ≤ 40 years old group;The level of serum uric acid in≤ 40 years old group was significantly correlated with serum lipids,while not correlated with e GFR and 24 h urinary protein quantitative;The level of serum uric acid in > 40 years old group had no correlation with other blood lipid indexes except HDL,and it was correlated with e GFR and 24 h urinary protein quantitative(P < 0.05).It suggests that hyperuricemia in young people with primary glomerular disease may be related to the increase of blood lipids,while the increase of uric acid level in older people may be related to the abnormality of urinary protein and renal function.3.Analysis of uric acid related factors of different pathological types: uric acidlevels of Ig A nephropathy were not significantly different from those of the other three groups;Uric acid levels of the four pathological types was correlated with e GFR;Ig A nephropathy,minimal change and FSGS were not correlated with urinary protein quantitative;For lipid metabolism: uric acid level was correlated with triglyceride in the Ig A nephropathy group;Uric acid level in the membranous nephropathy group was correlated with HDL;Serum uric acid level of the minimal chage group was correlated with cholesterol and albumin(P < 0.05);Serum uric acid level in the FSGS group was not correlated with all the above indicators(P > 0.05).4.Analysis of related factors of uric acid in Ig A nephropathy: There was no significant difference in serum uric acid levels between Ig A nephropathy group and non-Ig A nephropathy group(P > 0.05).To further exclude the effect of renal dysfunction on serum uric acid,Ig A nephropathy patients were divided into two groups according to e GFR difference:normal renal function group(e GFR > 90 ml/min.1.73 m2)and abnormal renal function group(e GFR ≤ 90 ml/min.1.73 m2).The serum uric acid level in abnormal renal function group was higher than that in normal renal function group;The serum uric acid in normal renal function group was positively correlated with triglyceride and negatively correlated with e GFR and HDL(P < 0.05).Ig A nephropathy patients were further divided into groups according to gender.The results showed that the serum uric acid level in male group was higher than that in female group(P < 0.001).Serum uric acid level was correlated with cholesterol in male group,and serum uric acid level was correlated with triglyceride and HDL in female group(P < 0.05).There was no correlation between serum uric acid and e GFR,and 24 h urinary protein in both groups.Ig A nephropathy patients were further divided into groups of > 40 years old and ≤40 years old.The level of serum uric acid in the group of > 40 years old was significantly higher than that in the group of ≤ 40 years old(P < 0.01);The level of uric acid in the group of ≤ 40 years old group was correlated with triglyceride,e GFR andHDL(P < 0.05),while not correlated with 24 h urinary protein quantitative(P < 0.05);The level of uric acid in the group of > 40 years old was positively correlated with cholesterol and 24 hours urinary protein quantitative(P < 0.05),while not correlated with e GFR.It suggests that serum uric acid in younger Ig A patients is mainly related to triglyceride and e GFR,while serum uric acid in older Ig A patients is mainly related to cholesterol and urinary protein quantitative.Scoring the pathological types of Ig A nephropathy patients according to Oxford classification,Ig A nephropathy patients were divided into high uric acid group and normal uric acid group.The results showed that there was no significant difference in M,E and S between the two groups(P > 0.05).The grading of tubulointerstitial lesions showed that the high uric acid group was significantly higher than the normal group with significant differences,of which T0(61.5% vs 87.2%,P < 0.05),T1(38.5% vs12.8%,P < 0.05).It suggests that hyperuricemia has a greater impact on tubulointerstitial lesions.Conclusion:1.Gender,renal function,blood lipids and urine protein quantification are the main factors for elevated uric acid in primary glomerular diseases.However,the level of uric acid in primary glomerulonephritis patients with renal dysfunction is not correlated with e GFR.2.There was no difference in uric acid level between Ig A nephropathy and other pathological types in this group.Abnormal renal function and abnormal lipid metabolism(especially triglyceride)are the main factors for the increase of Ig A uric acid.Chronic tubulointerstitial lesion is more obvious in Ig A nephropathy with hyperuricemia. |
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