A Study Of Factors Leading To The Rapid Progression Of IgA Nephropathy And Its Relationship With Prognosis

Objective To analyze the clinical,pathological and prognostic data of patients with IgA nephropathy(IgAN)with a few crescents,IgAN with partial crescents,fibrocellular crescentic IgAN,and to analyze their influences on prognosis.To observe the treatment and prognosis of malignant hypertension(MHT)complicated with thrombotic microangiopathy(TMA)for young patients with IgAN,and its relationship with the expression level of angiotensin receptors in the kidney(AT1R,AT2R,MASR),aldosterone receptors and renin.Method We collected the clinical,pathological and follow-up characteristics of patients with fibrocellular crescentic IgAN,IgAN with a few crescents,IgAN with partial crescents,young patients with IgAN with MHT and TMA in China-japan Friendship Hospital to explore the response to each therapy.The end-point is defined as end-stage renal disease,renal replacement therapy or death.Survival analysis were performed by the Kaplan-Meier survival curve and Log rank test.The expression of AT1R,AT2R,MASR,A1dR and renin in renal tissues of MHT complicated with TMA for young IgAN patients were observed by immunohistochemistry(IHC).Results ?The serum creatinine(SCr)level in patients with IgAN with a few crescents was 111.5±62.2 ?mo1/L,significantly lower than 143.5±64.1 ? mol/L in the partial crescents group.There was no difference between two groups of follow-up.Elevated SCr during renal perforation and absence of RAAS inhibitors were independent risk factors for renal prognosis of IgAN with a few crescents.?Fibrocellular crescentic IgAN were included,with an average age of 36.00±17.92 years.13 of them had endpoint events,and the median renal survival time was about 6 months.Patients treated with glucocorticoid and cyclophosphamide had a relatively good prognosis but increased adverse reactions.?Ten of young patients with IgAN with MHT and TMA entered the primary endpoint with a median follow-up of 11 months.Independent risk factors affecting prognosis for patients involved anemia,24-hour proteinuria?1.0g/d,decreased eGFR during renal biopsy and pathological capillary proliferative lesions.The expression of AT1R and AT2R in glomerulus,tubulointerstitium and renal vessels of the experimental group were significantly higher than those of the control group(P<0.01),and the expression of MASR in the glomerulus and renal vessels and the expression of AldR in the renal tubulointerstitium and renal vessels were significantly higher than those in the control group(P<0.01).There was significant positive correlation between the degree of proliferation in capillaries and the expression of AldR in renal tubules,and the expression of renin was positively correlated with the level of serum creatinine.Conclusion ?There is no significant difference between prognosis of patients with IgAN with a few crescents formation and those with partial crescents formation.?Patients with fibrocellular crescentic IgAN present rapid damage of renal function,severe lesion of renal pathology,and poor prognosis.Although to some extent glucocorticoid and immunosuppressive therapy have improved the prognosis,untoward drug effect are also increased,which should be closely monitored.?Young IgAN patients with MHT and TMA have poor prognosis,and those are all the main factors of disease progression,such as anemia,24-hour proteinuria?1.0g/d,and renal pathological severe damage.The activation of renin angiotensin aldosterone system plays an important role in the pathogenesis and progression of the disease.