Relationship Between Laboratory Results And Renal Pathological Grading In Purpura Nephritis

Objective: To investigate the relationship between routine test and renal pathological grading in HSPN.Methods: Fifty-three pediatric patients with HSPN who were first diagnosed by renal biopsy from January 2013 to October 2018 in the department of pediatrics of the first affiliated hospital of China medical university were selected for retrospective analysis of laboratory indicators and renal biopsy results in terms of urinary changes,coagulation changes and immunity.Spearman correlation analysis,kruskal-wallis nonparametric test and chi-square test were used to analyze the counting data,and the OR value was calculated.Binary multivariate Logistic regression model was used for analysis.ROC curve was used to evaluate the predictive effect of related indicators on the severity of glomerular and tubular injury.Results: A total of 53 children with HSPN were included in this study,including 26females(49.1%)and 27 males(50.9%).The mean age was 10.33 2.67 years.The median number of glomerular biopsies was 22.All patients with glomerular class I accounted for3.7%,? level accounted for 34.0%,? level accounted for 58.5%,? level accounted for 3.8%,there was no levels V and VI.All patients with renal tubular class(-)accounted for 7.5%,level(+)accounted for 75.5%,(+ +)level accounted for 9.5%,accounted for7.5%(+ + +)level.With the increase of pathological grading of glomeruli and renal tubules,the levels of urinary protein,urinary erythrocyte and other indicators were significantly increased.Indicators related to glomerular grading: 24-hour urine protein quantification,urine microprotein,urine erythrocyte number,and coagulation function.Indicators related to renal tubular grading: serum protein.There were statistically significant differences in glomerular grading between the light and severe groups in urine protein quantitation and urine microprotein,and statistically significant differences in renal tubular grading between the light and severe groups in serum protein.The analysis of the median,upper and lower quartile of each indicator in the pathological grading showed that,as the pathological grading of glomeruli and renal tubules increased,the levels of urinary protein,urinary erythrocyte and other indicators increasedsignificantly.The sensitivity and specificity of MA,TRU,D-D and urinary erythrocyte number were higher,which could be used to predict glomerular grading.IgM and serum protein can predict renal tubular grading.Conclusion: 1.24-hour urine protein quantification,urine microalbumin,urine transferrin,urine IgG,urine red blood cell number,FDP,D-D are correlated with glomerular grading,and most indicators are weakly correlated.Serum total protein and albumin were correlated with renal tubular grading,but the correlation was weak.2.The urine protein of the children with severe renal pathological changes was significantly higher than that of the children with mild renal pathological changes,while the serum protein was significantly lower than that of the children with mild renal pathological changes.When urinary microalbumin > 30mg/l,severe glomerular changes were 8.25 times as severe as mild changes.Urinary transferrin > at 2.41mg/l was 4.6 times higher.When the urine protein quantity is more than 50mg/kg,it is 1.89 times.When the total protein was less than 65g/L,the incidence of severe changes in renal tubules was 8.76 times higher than that of mild changes.Albumin < 40g/L is 12.71 times.In this study,d-d and elevated cholesterol were independent risk factors for glomerular grading.Patients with d-d abnormality were 13.77 times more likely to have severe renal pathological changes and4.29 times more likely to have abnormal cholesterol.3.Indicators such as MA,TRU,D-D and urine red blood cell number can be used to predict glomerular grading,and D-D has the best prediction effect;IgM and serum protein can predict renal tubular grading.