| Objective:To explore the clinicopathological features and prognosis of patients with IgA nephropathy(IgAN)with intrarenal arteriopathy.Methods:Retrospectively analyzed the clinicopathological data of 236 patients diagnosed as primary IgAN at the First Affiliated Hospital of Fujian Medical University from January 1st,2010 to December 30th,2018.According to the light microscope,whether the intrarenal small arteries have thickened blood vessel walls,arteriosclerosis,hyaluronic changes,onion skin-like hyperplasia and cellulose necrosis,these patients were divided into renal vascular lesion group(85 cases)and novascular lesion group(151 cases).Starting from the day of renal biopsy,the clinical and pathological data of the two groups were collected and followed up until December 30th,2019.Kaplan-Meier method was used to describe survival curves and log-rank test was conducted.Multivariate Cox proportional hazard model analysis was used to analyze the risk factors affecting the prognosis of IgAN patients.Results:(1)Among the 236 selected IgAN patients,intrarenal arteriolar lesions accounted for 36.02%.In the vascular lesion group,indicators such as age at onset,blood creatinine,blood urea nitrogen,blood triglyceride,the proportion of accompanying hypertension,and the proportion of kidney disease end event(ESRD or creatinine doubling)were higher than novascular lesion group(all P?0.05);Baseline e GFR,hemoglobin and serum Ig M levels were significantly lower than novascular lesion group(all P?0.05).Hemoglobin,blood uric acid,blood creatinine and baseline e GFR were stratified by gender and compared.The results showed that in vascular lesion group,the blood creatinine was still significantly higher than that in novascular lesion group(P?0.05),baseline e GFR and male hemoglobin were still significantly lower than that in novascular lesion groupp(all P?0.05),but the differences between blood uric acid and female hemoglobin levels were not statistically significant.Under light microscope,the proportion of patients with segmental sclerosis or adhesion,renal tubular atrophy/renal interstitial fibrosis in the vascular lesion group were significantly higher than that in the novascular lesion group(P<0.05).There was no significant difference in mesangial cell proliferation and endothelial cell proliferation between the two groups(both P>0.05).The results of immunofluorescence examination showed that there were no statistical differences in the deposition of Ig G,Ig M,C3 and C1q in the glomerular mesangial area between the two groups(all P>0.05).(2)Multivariate regression analysis showed that baseline e GFR,urinary protein quantification,concomitant hypertension and Ig M immunodeposition in the mesangial area were independent risk factors for kidney disease end event in IgAN patients with renal vascular disease(OR values were 0.987,0.765,0.234,3.130,respectively,all P?0.05).A total of 23 patients(9.75%)of IgAN patients enterd kidney disease end event,of which 17 patients had doubled serum creatinine and 6patients entered ESRD.In the vascular lesion group,the median follow-up time was39 months,14(16.47%)patients enterd kidney disease end,11 patients had doubled serum creatinine and 3 patients entered ESRD.The vascular lesions group had a higher proportion of events entering kidney disease end than the novascular lesions group(P<0.05).Kaplan-Meier curve analysis showed that the renal cumulative survival rate in the vascular lesion group was lower than that in the novascular lesion group(Log-rank test,χ~2=4.430,P=0.035).Conclusion:The prognosis of patients with IgAN with intrarenal arteriopathy is poor.Low baseline e GFR,high urinary protein,associated hypertension,and Ig M immune deposition are significantly associated with intrarenal arteriopathy. |
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