Correlation Between Proteinuria And Hematuria Levels And Oxford Classification Of IgA Nephropathy 2016 Edition

[Objective]To study the correlation between different levels of proteinuria and hematuria and linical features and 2016 Oxford classification(MEST-C score)of Ig A nephropathy;So as to early and timely intervention,formulate accurate treatment plan,improve the prognosis of patients,improve the quality of life of patients.[Method]According to the conditions,Ig AN patients diagnosed by renal biopsy in Xiangya Second Hospital of Central South University in 2011 and 2013 and Ig AN patients diagnosed by renal biopsy in Subei People's Hospital of Jiangsu Province in2012.7-2018.11 were included.All the patients were divided into five groups according to the level of proteinuria: 1)group A(24h-UP ? 0.5g/d),2)group B(0.5g/d < 24h-UP ?1g/d),3)group C(1g/d < 24h-up ? 2g/d),4)group D(2g/d < 24h-up ? 3g/d);E group(24h-UP > 3 g/d).According to hematuria,the patients were divided into three groups:group ?: no hematuria(urinary sediment red blood cell count ? 25/ul),group ?: low hematuria(25/ul < urinary sediment red blood cell count ?100/ul),and group ?: high hemuria(urinary sediment erythrocyte count >100/ul).The correlations of clinical and pathological parameters between hematuria and proteinuria were compared.The risk factors of proteinuria and hematuria were analyzed by linear regression.ROC curve was used to analyze the value and cutoff value of proteinuria and hematuria for MEST-C.[Result]A total of 603 patients were enrolled based on eligibility.Proteinuria: clinical indicators: 1)The level of proteinuria has no significant difference with sex,preceding infection,urine sediment red blood cell count,hemoglobin,hypohemoglobinemia,high density lipoprotein cholesterol and serumimmune globulin Ig A and Ig M,.(p>0.05).2)Age,systolic blood pressure,diastolic blood pressure,mean arterial pressure,uric acid,urea nitrogen,serum creatinine,triglyceride,total cholesterol,low density lipoprotein cholesterol,complement(C3,C4),hypertension,hypoalbuminemia,hyperuricemia,hyperlipidemia and hypertriglyceridemia were positively correlated with proteinuria(p<0.05).3)Gross hematuria,serum total protein,albumin,serum Ig G and e GFR were negatively correlated with proteinuria,and there was statistical difference.(p<0.05).Pathological parameters: 1)Mesangial hypercellularity(M),segmental glomerulosclerosis(S),interstitial fibrosis/tubular atrophy(T)and cellular/fifibrocellular crescents(C)were positively Linear correlated with proteinuria(p<0.05).The highest proportion of C1 q deposition is in E group(p<0.05).Group C,D and E had more severe segmental glomerulosclerosis(S),interstitial fibrosis/tubular atrophy(T)and cellular/fifibrocellular crescents formation(C)than group A(p<0.05).Even in group A,the proportions of segmental glomerulosclerosis(S1),interstitial fibrosis/tubular atrophy(T1 and T2)and cellular/fifibrocellular(C1)were 57%,11.6%and 26.6%,respectively.The cutoff value of 24h-proteinuria for predicting Mesangial hypercellularity was 0.995(AUC = 0.692,sensitivity 0.484,specificity 0.900).The cutoff value for segmental glomerulosclerosis was 0.975(AUC = 0.624,sensitivity0.557,specificity 0.665).The cut-off value of interstitial fibrosis/tubular atrophy was 1.194(AUC = 0.704,sensitivity 0.648,specificity 0.678),and the cut-off value of cellular/fifibrocellular crescent was 0.576(AUC = 0.650,sensitivity 0.816,specificity0.429).Hematuria: Clinical indicators:The level of hematuria was not related to proteinuria,low hemoglobin and hypoalbuminemia.With the degree of hematuria increasing,The lower age,systolic blood pressure,mean arterial blood pressure,uric acid,creatinine,triglyceride,total cholesterol,serum total protein,albumin,hemoglobin(p<0.05),and the proportion of gross hematuria,prodromal infection,hyperuricemia and hypertension increased(p <0.05).Pathological indicators: hematuria and cellular/fifibrocellular crescent formation was positively correlated(p<0.05),Interstitial fibrosis,renal tubular atrophy and C1 q deposition were the most severe in non-hematuria group(p<0.05).There was no significant difference between hematuria and MEST-C ? 3(p>0.05).[Conclusion]In This study,we retrospectively analyzed the clinical data of patients with Ig AN who met the inclusion criteria,and reached the following conclusions:1.As a whole,the more obvious the 24h-urinary protein,the more severe the pathological damage.1).With increasing proteinuria level,the patients with proteinuria > 1g/d had more severe renal pathological lesion,especially mesangial proliferation(M),segmental glomerulosclerosis(S),interstitial fibrosis/tubular atrophy(T)and cellular/fifibrocellular crescent formation(C);Proteinuria was the best predictor of tubulointerstitial fibrosis/tubular atrophy.2).Patients with proteinuria levels greater than 0.5 g/d had a significantly increased risk of developing cellular/fifibrocellular crescent.3).Even in patients with proteinuria less than 0.5 g/d,there are still pathological lesions such as high proportion of segmental glomerulosclerosis(S1),interstitial fibrosis/tubular atrophy ratio(T1 and T2),crescent(C1)and so on,especially segmental glomerulosclerosis.2.The prognosis of hematuria may be better,which is still closely related to the occurrence of cellular/fifibrocellular crescent.