Clinical And Pathological Features Of Primary IgA Nephropathy In Children With Gross Hematuria

Objective:analyze the clinical and pathological features of primary IgA nephropathy in children with gross hematuria.Methods:222 cases was collected which was biopsy-proven IgAN,According to the gross hematuria occurred or not,it is divided into gross hematuria group and non gross hematuria group.The clinical manifestations,laboratory examination results and renal pathological characteristics of the two groups were analyzed.Results:(1)222 children with IgA nephropathy were included,including 164 cases(73.9%)with gross hematuria and 58 cases(26.1%)without gross hematuria.There were no statistically significant differences in gender,age distribution,and prodromal infection between the two groups(χ~2=1.099,t=-1.285,χ~2=0.21;P>0.05),and the course of disease in children with visual hematuria was significantly shorter than that in children without visual hematuria,with statistically significant differences(t=2.835,P=0.006).(2)The incidence of serum uric acid and hyperuricemia in children with gross hematuria was significantly lower than that without gross hematuria(t=15.5,χ~2=8.79;P<0.05).Theincidenceofhypertension,hypercholesterolemia,proteinuria,hypoproteinemia and IgA levels were significantly lower than those of the latter,with statistically significant differences(χ~2=5.878,11.725,5.176,4.78;P<0.05).There were no statistically significant differences in the incidence of anemia,serum creatinine and C4 levels in the two groups(χ~2=0.23,t=-0.22,t=1.1;P>0.05).(3)Lee classification of children with or without gross hematuria IgAN was the highest in grade III,accounting for 53.0%and 37.9%respectively.There was no statistically significant difference in Lee grading distribution between the two groups(χ~2=8.167,P=0.086).(4)The incidence of pathological lesion indicators M1 and crescent in children with gross hematuria was significantly higher than that in children without gross hematuria(χ~2=4.239,6.658;P<0.05),while the incidence of S1 and spherosclerosis was significantly lower than that in children without gross hematuria(χ~2=6.187,4.571;P<0.05).No statistically significant differences in the incidence of E1,T1 and vascular thickening(χ~2=1.949,0.072;P>0.05).(5)IgA with capillary loop deposition in children with gross hematuria was significantly less than that in children without gross hematuria(χ~2=4.191,P=0.041).Intensity of two groups of children with IgA,C3 deposition was statistically difference(χ~2=22.317,17.772,P=0.000),the Kruskal-Walli H test comparing two later found,with the naked eye hematuria in children with IgA and C3 deposition strength 1+were significantly higher than those without children with the naked eye hematuria,and the intensity of IgA deposits 3-4+and C3 deposition strength 2+significantly lower than the latter.There was no statistically significant difference in IgG and IgM distribution intensity between the two groups(χ~2=1.085,7.157;P>0.05).Conclusion:(1)In children with gross hematuria,incidence of hypertension,hyperuricemia,hypoalbuminemia,hypercholesterolemia and hyperproteinuria is lower.(2)In children with gross hematuria,staging of renal pathological chronic lesions is mild,with obvious active lesions,and IgA and C3 deposition intensity is weak,suggesting a relatively good prognosis.