Histopathological Changes Of IgA Nephropathy And Expression Of PRR,PRCP And ACE2 In IgA Nephropathy And Its Pathological Significance

Objective:To study the epidemiological and pathological features of IgA nephropathy(IgA N)in Guizhou Province,and to investigate the expression and significance of renin-angiotensin(RAS)system related protein renin receptor(PRR/ATP6AP2),Prolylcarboxypeptidase(PRCP)and angiotensin converting enzyme 2(ACE2)in IgA nephropathy tissue.Methods:A total of 648 cases of renal puncture tissue were collected,and their epidemiological and pathological changes were statistically analyzed according to their pathological types.Then 74 cases were randomly selected as experimental group,including 20 cases of focal hyperplasia IgA N,20 cases of IgA nephropathy complicated with membranous nephropathy(MN)and 14 cases of diffuse crescent formation IgA N.And 20 cases of minimal change disease(MCD)were randomly selected as control group.The expression of PRR,PRCP and ACE2 was detected by immunohistochemical method.And the relationship between the lesions and the degree of various types of IgA nephropathy was analyzed.Results:1.Epidemiological characteristics:The age span of IgA nephropathy was 7-79 years old,and the median age was 31 years old.the proportion of male and female was 3:2.The difference of age in different pathological types was statistically significant(P<0.05).The age of mild mesangial proliferation and diffuse endocapillary proliferation was young.2,Histopathological features:(1)The most common pathological type was mild mesangial proliferation[35.0%(227/648)],and the second type was focal proliferation[25.6%(166/648)].(2)The most common type of protein deposition in glomerular was IgA+IgM[86.1%(558/648)],and the second one was IgA+C3[66.6%(432/648)1.Fluorescence intensity is mainly(+).There IV were significant differences in glomerular deposition among IgA,IgG,IgM and C3 in different pathological types(P<0.05),with the highest deposition in diffuse endocapillary proliferation.And there was no significant difference in glomerular deposition of Clq and Fib in different pathological types(P>0.05).(3)There were significant differences in different pathological types of lesions such as crescent body,renal artery thickening,renal tubular atrophy,interstitial fiber hyperplasia and brush margin shedding of renal tubular epithelial cells(P<0.05),which were more serious in diffuse proliferation and sclerosis,diffuse sclerosis and focal proliferation and sclerosis.(4)In IgA nephropathy,the most common cast type was protein type[80.7%(523/648)1.The difference of protein type,red blood cell type and renal tubular epithelial cell type were statistically significant in various types(P<0.05).And the incidence of cast type increased with the increase of lesion degree.There was no significant difference in the occurrence of granular cast type in each type(P>0.05).3.Immunohistochemical results:PRR,PRCP and ACE2 were located in the glomerular and renal tubules.The expression of IgA Nephropathy Group was higher than that of MCD Group(P<0.05).With the severity of the lesion,the expression of three proteins in glomerular area increased gradually in glomerular area(P<0.05)while that decreased gradually in the renal tubular region(P<0.05).The expression of three proteins was positively correlated(r=0.393,0.433,0.274,P<0.05).The expression of PRR and ACE2 in glomerular region was negatively correlated with the deposition of IgA in glomerular(r=-0.375,-0.301,P<0.05),and its expression in renal tubules was positively correlated with that(r=0.555,0.306,P<0.05),The expression of PRCP was not correlated with the deposition of IgA(P>0.05).Conclusion:1.The main subject of IgA nephropathy in Guizhou Province is young people.And male is more common than female.Mild mesangial proliferation is the most common pathological type.The deposition of IgA+IgM is most common in glomerular.The pathological changes of glomerular,renal tubules and interstitial are becoming worse with increased degree of different pathological types.2.The subjects of diffuse endocapillary proliferation IgA N are young,which has high glomerular protein deposition.It may indicate poor prognosis of this type.3.Three proteins PRR,PRCP and ACE2 in the RAS system were expressed in the renal tissue of IgA nephropathy.And with the increase of lesions,the expression in the glomerular region showed an upward trend and that in the renal tubular region showed a downward trend,suggesting that the RAS system may play a role in the development of IgA nephropathy.And the expression level of PRR,PRCP and ACE2 can predict the degree of renal lesions and the prognosis of disease.