| Objective:To retrospectively analyze the clinical and pathological features of patients with primary Ig A nephropathy in our hospital and to explore the risk factors for poor prognosis of Ig A nephropathy.Methods:204 patients with Ig A nephropathy diagnosed by renal biopsy from January 2010 to December2021 in our hospital were selected,and their general,clinical,pathological,and follow-up data were collected.We divided the 204 patients with Ig A nephropathy into groups according to WHO classification,Oxford classification,proteinuria level,and uric acid level.Analyzed the clinical,pathological,and prognosis relationship in layers.Risk factors of poor prognosis of Ig A nephropathy analyzed by COX regression.Results:1.Ig A nephropathy accounted for 24.43%of renal biopsies in the same period,the male-female ratio was 1:1.2,the average age was 38.38±11.49 years,and the course of the disease was skewed from 1 day to 15years.24h urine protein quantification<0.3g/d(group A),0.3-0.99g/d(group B),1-1.99g/d(group C),and≥2g/d(group D)accounted for 23.53%,32.84%and 21.08%of the total population respectively.The initial estimated glomerular filtration rate(e GFR)of 14.71%before the renal biopsy was less than 60ml/min/1.73 m~2;The renal biopsy was in the CKD1 stage.Most patients were in CKD1 stage at renal biopsy,accounting for 61.27%of the total number.67.15%patients were positive for occult blood in urine tests.2.(1)In the WHO classification,patients with type III account for the most,and the WHO classification increases with the increase of total cholesterol(TC),creatinine(Scr),urea nitrogen(BUN),and 24h-UP urine protein.The cumulative survival rate of typeⅡkidney is higher than that of type V kidney.(2)In Oxford classification,M1,E0,S1,T0,and C0 account for a relatively high proportion,and M negatively correlated with albumin(Alb),total protein(TP),and serum Ig G and positively correlated with uric acid(UA);E negatively correlated with hemoglobin(Hb).T positively correlated with Scr and UA;C was negatively correlated with Hb and Alb,positively correlated with Scr and BUN,and S not correlated with clinical indexes.The cumulative survival rate of the kidney in the T2 group was low,while that in the C0group was high.3.There were significant differences in Alb,TP,Scr,BUN,e GFR,TC,serum Ig G,Oxford Grading M,T,C,and WHO among the four groups of patients with different proteinuria levels.With the decrease of Alb,TP,e GFR,and serum Ig G and the increase of Scr,BUN,and TC,24h-UP increased.In terms of cumulative renal survival rate,group A was the highest and group D was the lowest,and there was no difference between groups B and C.4.There are more men in the hyperuricemia group.The systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),serum glucose(GLU),Scr,BUN,triglyceride(TG),TC,serum Ig G,and 24-UP are all higher.The e GFR is lower,and the Oxford classification is M and T.UA positively correlated with SBP,DBP,MAP,GLU,Scr,BUN,TG,TC,and 24h-UP.It negatively correlated with e GFR and serum Ig G.The cumulative survival rate of kidneys in the hyperuricemia group was lower.5.COX regression analysis showed that Scr,UA,24h-UP,and Oxford Grade T2 were independent risk factors for the progression of Ig A nephropathy.Conclusion:1.There is a correlation between pathological grades of Ig A nephropathy and clinical indexes.The type V of WHO classification,T2,C1,C2 of Oxford classification,24h-UP≥2g/d,and the high uric acid level of Ig A nephropathy patients had worse renal function and shorter survival.2.Scr,UA,24h-UP,and Oxford Grade T2 in the renal biopsy are independent risk factors for the progression of Ig A nephropathy.The patients with these risk factors should actively intervene to delay the disease’s progression and improve their prognosis. |
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