Clinicopathological And Prognostic Study Of IgA Nephropathy With Focal Crescents Formation

ObjectiveTo retrospectively study the clinicopathological manifestations and TCM syndromes of IgA nephropathy with focal crescents formation,and further explore the influence of focal crescents and its size and volume on prognosis.Provide reference for clinical and TCM treatment of IgA nephropathy.MethodsUsing retrospective research methods,from September 1,2005 to December 31,2017,all patients in Guangdong Provincial Hospital of TCM and Shaanxi Provincial Hospital of TCM diagnosed with no obvious chronic IgA nephropathy by renal biopsy,a total of 305 cases were eligible standards enter this study.Collect and sort out the demographic data,clinical data,TCM syndromes and other relevant baseline indicators of patients with renal puncture.The patients were divided into several groups according to the presence or absence of a globalcrescent:No crescent group(NC),only segmental crescents group(SC),global crescents group(GC).To summarize clinical pathological manifestations and TCM Syndromes ofthe proportion and volumesof crescents.During follow-up period,the clinical data and the situation of TCM and Western medicine were collected.The outcome was the survival from a combined event defined by a≥15%decline in the estimated glomerular filtration rate(eGFR)at one year or ≥30%decline in the eGFR at two years.The prognostic analysis were performed by using Kaplan-Meier analysis and Cox regression analysis.Results:A total of 305 patients with no obvious chronic IgA nephropathy were enrolled in this study.The median follow-up time was 33.67(26.16-57.10)months.A total of 34 patients(11.1%)had a composite endpoint event.According to the Crescent(C)score,231 cases were in C0 group,74 cases were in C1 group.And according to the presence or absence of global crescents:231 cases in No crescent group(NC),45 cases were in only small crescent group(SC),29 cases were in global crescent group(GC).In terms of baseline analysis,there are significant differences in eGFR,urine protein quantification,urine red blood cell count,total cholesterol,Low-density lipoprotein,blood IgA,Oxford type mesangial cell proliferation(M),capillary endothelial cell proliferation(E),segmental glomerular sclerosis(S),tubular atrophy/interstitial fibrosis(T),mesangial IgA and C3 deposited in the group of C score.There are significant differences in eGFR,serum creatinine,urine protein quantification,urine red blood cell count,Total cholesterol,low-density lipoprotein,serum albumin,blood IgA,blood complement C3,Oxford Classification M1,E1,S1,T1,mesangial IgAandC3 deposited in the crescent volume group.In terms of TCM symptoms,main symptomof patients with no obvious chronic IgA nephropathy are qi deficiency of spleen and kidney,combined with blood stasis syndrome or damp-heat with blood stasis syndrome.In the prognosis analysis,the K-M survival curve showed that Cl score,global crescent group and TCM syndrome of water-dampness with blood stasis had poor prognosis.Univariate cox regression analysis showed that female,mean arterial pressure,higher baseline eGFR,triglyceride,C score,GC group,steroid,immunosuppressive therapy,Haikunshenxi capsule,water-dampness with blood stasis were associated with the endpoint.In multivariateCox regression model,compared with NC group,GC group(HR=2.756,95%CI=1.068-7.109,P=0.036)had a higher increased risk of composite endpoint events at the same time;women,MAP and serum triglyceride were independent prognostic factors.Conclusion:InIgAN patients without obvious chronicrenallesions,GC group had more severe clinical and pathological manifestations than those without crescents.Complement activation may be related to the formation of IgAN global crescent.The formation of global crescent is related to damp-heat syndrome or Damp heat and blood stasis syndrome.Global crescent、female、MAP、Serum triglycerides、Haikun Shenxi Capsule are independent risk factor for the progression of IgAN renal function.