血、尿NGAL与IgA肾病临床与病理的相关性研究

目的:探讨血、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平与IgA肾病(IgAN)患者临床与病理表现的关系。方法:选择初次诊治经肾活检病理检查确诊为IgAN且未经激素或免疫抑制剂治疗的患者40例,同时选择10例健康体检者作为对照。收集临床和病理资料,应用酶联免疫吸附法(ELISA)检测血、尿NGAL水平,并分别用IgAN牛津分型和Katafuchi半定量标准对病理进行评分。分析血、尿NGAL与IgAN患者临床及病理指标的相关性。结果:血、尿NGAL反映IgAN肾功能情况较血肌酐(Scr)、血尿素氮(BUN)更敏感,与高血压、Scr、BUN、牛津分型的系膜增殖积分(M)、间质纤维化或小管萎缩(T)以及Katafuchi分型的系膜增殖、局灶节段病变、球性硬化、炎细胞浸润、间质纤维化、肾小管萎缩、血管壁增厚、小动脉玻变等多个指标相关性分析差异均有统计学意义(P<0.05,部分P<0.01),尤其与肾小管间质损伤各项指标(炎细胞浸润、间质纤维化、肾小管萎缩)显著相关(r均>0.6,P<0.01)。ROC曲线表明血、尿NGAL在IgAN中反映小管间质病变程度方面明显优于Scr和肾小球滤过率(eGFR),血NGAL在反映小管间质病变程度方面比尿NGAL敏感度和特异度更高。结论:血、尿NGAL水平与IgA肾病临床及病理多个指标相关,更能反映肾小管间质损伤程度,可以作为评估IgA肾病小管间质病变的早期无创性指标。     

IgA肾病肾功能状态与病理分级的探讨

目的建立能够准确反映IgA肾病(IgAN)肾功能状态的病理分级系统.方法按照K/DOQI指南推荐的公式成人(简化MDRD公式)估算GFR=186×血清肌酐(mg/dl)-1.154×年龄(岁)-0.203×(0.724,如果为女性)×(1.210,如果为黑人);儿童(Counahan-Barratt公式)估算GFR=0.43×身高(ca)/血清肌酐(mg/dl),计算861例IgAN患者的估算GFR,并按照K/DOQI指南对IgA肾病进行肾功能分期.应用半定量病理积分方法对9项病理指标(包括系膜增殖、球囊粘连/小新月体、新月体、节段硬化、全球硬化、肾小管萎缩、间质纤维化、间质炎细胞浸润、血管病变)与IgAN GFR分期进行了等级相关和有序logistic多因素分析,寻找与IgAN肾功能状态确切相关的病理指标.根据与IgA肾病肾功能状态确切相关的病理指标进行病理分级,通过ROC曲线比较该病理分级系统与传统Lee分级反映IgAN患者肾功能损害的敏感性和特异性.结果全球硬化、肾小管萎缩、间质纤维化、血管病变与IgAN肾功能分期呈等级相关,根据该4项病理指标积分进行的分级(GTIV,为四项病理指标的英文单词第一个大写字母缩写)与Lee分级相比,反映IgAN肾功能分期的敏感性和特异性更高(P值均小于0.001).结论全球硬化、肾小管萎缩、间质纤维化、血管病变是与IgA肾病肾功能状态相关的病理因素.与Lee分级及单项病理指标相比,GTIV分级系统反映IgA肾病肾功能状态的敏感性和特异性更高,该分级系统可能更适用于临床科研探讨和预后的判断.     

血清IgM水平与IgA肾病疾病严重程度及预后的相关性

本研究纳入252例原发性IgA肾病(IgAN)患者为研究对象,按照肾穿刺时血清IgM中位数水平分为低IgM水平组和高IgM水平组。结果示低IgM水平组(<1.015 g/L)患者的年龄、男性占比、血尿素氮、血尿酸、尿蛋白量、收缩压、用激素/免疫抑制剂占比、肾脏病理肾小管萎缩或间质纤维化分型占比较高IgM水平组高,血清IgG、C3水平较低(均P<0.05)。Kaplan-Meier生存曲线分析结果显示,低IgM水平组肾脏累积生存率低于高IgM水平组(χ2=7.123,P=0.008)。多因素Cox回归分析结果显示,低IgM水平是IgAN患者肾脏不良预后的危险因素。提示低血IgM水平IgAN患者的临床及肾脏间质病理改变更严重,低IgM水平是IgAN患者进展至终末期肾脏病的独立危险因素。     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。     

IgA肾病患儿小管间质和小球损伤关系的探讨

目的:探讨IgA肾病(IgA nephropathy,IgAN)患儿肾小管间质损伤和肾小球损伤的关系。方法:对2006年1月～2011年12月经肾活检确诊为IgAN的84例患儿的肾脏病理改变进行分析。结果:44例(52.4%)存在不同程度的肾小管间质损伤,其中肾小管间质损伤Ⅰ级20例(23.8%),Ⅱ级21例(25.0%),Ⅱ级3例(3.6%)。肾小管间质损伤与Lee分级呈正相关(r=0.605,P<0.05)。中度以上系膜增殖在肾小管间质损伤Ⅰ、Ⅱ、Ⅲ级组的发生率明显高于0级组(P<0.05,P<0.01,P<0.01);球囊黏连在肾小管间质损伤各组间发生率的差异无统计学意义(P>0.05);新月体形成在肾小管间质损伤Ⅰ、Ⅱ级组的发生率明显高于0级组(P<0.01),Ⅲ级组新月体形成减少,与0级组比较差异无统计学意义(P>0.05);球性硬化在肾小管间质损伤Ⅱ级组的发生率明显高于0级组(P<0.05),Ⅲ级组的发生率明显高于0级(P<0.01)和Ⅰ、Ⅱ级组(P<0.05)。结论:多数IgAN患儿存在肾小管间质损伤。肾小管间质损伤与肾小球损伤相关联,尤其与中度以上系膜增殖、新月体形成和球性硬化密切相关,其中系膜增殖贯穿肾小管间质损伤的始终。肾小管间质损伤可能是IgAN进展的重要原因,而肾小球损伤又将进一步加重肾小管间质损伤。     

尿N-乙酰-β-D氨基葡萄糖苷酶在IgA肾病肾小管间质损伤中的评估价值

目的评估尿N-乙酰-β-D氨基葡萄糖苷酶在IgA肾病肾小管间质损伤中的价值。方法回顾性分析2014年2月至2018年6月于本院行肾穿刺活检确诊为IgA肾病的患者82例,分为NAG正常组(NAG<12 U/L,14例)、NAG升高组(NAG>12 U/L,68例);分析两组患者间临床与病理指标的差异,并评估NAG与肾小管间质病变的相关关系。结果NAG正常组的NAG、血肌酐、胱抑素-C、尿微量白蛋白的统计量显著低于NAG升高组(P<0.05),NAG正常组的eGFR的统计量显著高于NAG升高组(P<0.05),病理改变中,NAG正常组的肾小球系膜细胞增殖、肾间质炎症细胞浸润、肾间质纤维化、肾小管萎缩积分显著低于NAG升高组,进一步logistic回归分析显示微量白蛋白、eGFR、系膜增殖、肾小管间质的病理改变为影响NAG水平的独立危险因素。结论尿NAG水平与患者eGFR、mALB以及小管间质病变密切相关,可以作为评估和监测IgAN的小管间质病变程度的临床指标。     

同型半胱氨酸预测IgA肾病患者肾脏预后不良的价值

目的探讨同型半胱氨酸(homocysteine, Hcy)早期预测IgA肾病(IgA nephropathy, IgAN)肾脏预后不良的临床价值。方法回顾性分析广西医科大学第一附属医院原发性IgAN患者的临床资料, 依据血Hcy水平将患者分为高Hcy组(Hcy>15 μmol/L)和Hcy正常组(Hcy≤15 μmol/L), 比较两组患者间临床病理指标的差异。采用Cox回归模型法分析肾脏预后不良的危险因素。Kaplan-Meier生存曲线和Log-rank检验比较两组患者肾脏累积生存率的差异。结果 196例IgAN患者入选, 男女比为1.15∶1, 年龄(37.01±10.95)岁。高Hcy组62例(31.6%), Hcy正常组134例(68.4%)。与Hcy正常组比较, 高Hcy组患者男性比例、收缩压、血白蛋白、血肌酐及血尿酸水平均较高, 高密度脂蛋白胆固醇和估算肾小球滤过率均较低, 肾小管萎缩/间质纤维化程度较严重, 细胞/纤维细胞性新月体比例较高(均P<0.05)。Cox回归分析结果显示, 随访(30.0±16.0)个月, 基线高Hcy血症是IgAN肾脏预后不良的独...     

供肾移植术后IgA肾病的临床病理特点与预后的关系

目的分析及讨论供肾移植术后IgA肾病(IgAN)的临床病理特点及其潜在的危险因素。方法回顾性分析2016年1月至2019年9月经指征性移植肾活检诊断为IgAN的受者临床病理特点, 对受者移植时和移植后的一般临床资料以及病理牛津分型进行统计分析, 探讨供肾移植后IgAN的临床病理特点及其危险因素。结果移植后IgAN的诊断率约12.77 %(18/141);平均移植后22.5个月出现临床症状;受者移植肾功能分布在CKD 1-4期, 其中66.67 %(12/18)处于CKD 3-4期;76.92 %的患者伴随镜下血尿, 88.89 %的患者有不同程度蛋白尿。病理参数积分情况如下:系膜细胞增生78 %、内皮细胞增生17 %、节段硬化65 %、中重度小管萎缩/间质纤维化39 %、新月体形成17 %。小管萎缩/间质纤维化与活检时的估算肾小球滤过率(P<0.05)相关;尿蛋白定量>1 g/d组与<1 g/d组受者间的节段硬化、球囊粘连的差异有统计学意义(P<0.05)。结论病理牛津分型在移植后IgAN的诊断中有一定临床价值:(1)小管萎缩/间质纤维化与移植肾功能下降相关;(...     

存在肾小动脉微血管病变且非高血压IgA肾病患者的临床病理特点和预后分析

目的总结和分析非高血压的IgA肾病(IgA nephropathy,IgAN)合并肾小动脉微血管病变(microangiopathy,MA)患者的临床病理特点和预后。方法抽取北京大学第一医院IgAN前瞻性队列人群中非高血压成人患者,重新进行病理阅片,根据肾小动脉病变,分为MA组、动脉硬化病变(AS)组和无血管病变组,分析其临床病理及预后特点。复合肾脏终点事件包括终末期肾病或估算肾小球滤过率(eGFR)下降≥30%。采用Cox回归模型分析预后的危险因素。结果共420例IgAN患者被纳入本研究,其中37(8.8%)例患者合并MA,134(31.9%)例合并AS,其余249例无血管病变。相对于AS组或无血管病变组,合并MA的患者尿蛋白量更严重[1.47(1.08,2.84)g/d比1.31(0.68,2.56)g/d、1.04(0.55,2.00)g/d,P=0.002],肾功能更差[eGFR:(75.3±26.5)ml·min-1·(1.73 m2)-1比(85.7±27.0)ml·min-1·(1.73 m2)-1、(98.6±24.8)ml·min-1·(1.73 m2)-1,P<0.001],并有更高的节段性肾小球硬化和(或)球囊粘连(S1)、肾小管萎缩/间质纤维化(T1/2)、细胞/细胞纤维新月体病变(C1/2)比例(均P<0.05)。随访期间,合并MA的患者发生终点事件比例更高[54.1%比33.6%、32.9%,χ2=6.491,P=0.039]。Cox多因素分析模型显示,MA是IgAN发生进展的独立危险因素(HR=1.872,95%CI 1.044~3.357,P=0.035),而其他类型血管病变不影响预后。结论非高血压IgAN患者合并MA不少见,这提示高血压并非导致IgAN血管病变的唯一危险因素。     

贫血加重IgA肾病患者的临床和病理改变

目的 分析IgA肾病合并贫血患者的临床病理特征.方法 收集经肾活检确诊的IgA肾病患者临床资料409例,按照贫血与否分为非贫血组和贫血组,回顾性分析两组患者的临床和病理资料.结果 与非贫血组比较,贫血组患者的肾小球损伤和肾小管间质萎缩程度较重、24 h尿蛋白增多和eGFR降低.Spearman相关分析结果显示,血红蛋白、eGFR与肾脏病理损伤呈负相关(P＜0.05),血尿酸、24h尿蛋白与肾脏病理损伤呈正相关(P＜0.05).多因素Logistic回归分析发现贫血是肾小管间质萎缩的独立危险因素.结论 IgA肾病合并贫血患者的临床和病理损伤重于IgA肾病非贫血的患者,贫血参与IgA肾病的进展.     

Clinicopathological and prognostic analysis of IgA nephropathy patients with anemia

Objective To analyze the clinicopathological features of IgA nephropathy (IgAN) patients with anemia and the influencing factors of prognosis. Methods The clinical and pathological data of patients diagnosed with primary IgAN at the First Affiliated Hospital of Fujian Medical University from January 1, 2006 to December 31, 2016 were retrospectively analyzed. The patients were divided into anemia group and non-anemia group according to whether the patient was anemia or not. The clinical and pathological data of the two groups were collected. All of them were followed up from the date of renal biopsy to January 1, 2018. Survival curves of the two groups were drawn by Kaplan-Meier method, and compared by Log-rank test. Multivariate Cox proportional hazards regression model was adopted to explore the influencing factors of prognosis in IgAN patients. Results A total of 231 subjects were enrolled, including 122 males (52.8%), and the male-female ratio was 1.12∶1. Their age was (34.8±10.1) years (15-68 years). There were 70 patients (30.3%) in anemia group, 161 cases (69.7%) in non-anemic group. Compared with non-anemia group, anemia group had higher proportion of females, lower serum albumin, higher proportion of tubular atrophy/interstitial fibrosis (T1/2), endothelial cell proliferation (E1) and crescent formation (C1/2), which were statistically significant (all P＜0.05). The patients had a median follow-up time as 6.3 years (0.3-12.9 years). Survival analysis showed that patients in anemia group had lower cumulative renal survival rate than that in non-anemia group ( χ2=15.234, P＜0.001). Multivariate Cox hazards regression analysis revealed that anemia (HR=3.820, 95%CI 1.674-8.719, P=0.001), tubular atrophy/interstitial fibrosis (T1/2) (HR=3.770, 95%CI 1.026-13.852, P=0.046), glomerular segmental sclerosis/adhesion (S1) (HR=4.211, 95%CI 1.139-15.576, P=0.031), hypertension (HR=2.988, 95%CI 1.276-6.999, P=0.012), increased 24 h urinary protein (HR=1.103, 95%CI 1.046-1.163, P＜0.001) and estimated glomerular filtration (eGFR)＜60 ml?min-1?(1.73 m2)-1 (HR=3.725, 95%CI 1.639-8.462, P=0.002) were the independent risk factors for poor renal prognosis in patients with IgAN. Conclusions The clinicopathological features of IgAN patients with anemia are relatively serious, and the renal cumulative survival rate is lower. Anemia, tubular atrophy/interstitial fibrosis (T1/2), glomerular segmental sclerosis/adhesion (S1), hypertension, increased urinary protein and eGFR＜60 ml?min-1?(1.73 m2)-1 are the independent risk factors for poor renal prognosis in patients with IgAN.     

The correlation between serum levels of oxidative stress indicators and renal interstitial fibrosis in patients with IgA nephropathy

Objective To investigate the relationship between serum levels of oxidative stress indicators and the degree of renal interstitial fibrosis in patients with IgA nephropathy (IgAN). Methods Seventy eight patients with confirmed primary IgAN in General Hospital of Ningxia Medical University from January 2013 to December 2014 were enrolled. The patients were divided into T0 group (n=30), T1 group (n=26) and T2 group (n=22) according to the grade of tubular atrophy/interstitial fibrosis of Oxford pathological classification criteria for IgAN in 2009. Meanwhile, thirty cases of health examiner were enrolled as control subjects. The levels of serum malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-Px) were detected by xanthine oxidase method, thiobarbituric acid spectrophotometry method, ultraviolet spectrophotometry method, chemical colorimetric method, respectively. The levels of serum advanced oxidation protein products (AOPPs), transforming growth factor beta 1 (TGF-β1), monocyte chemotactic protein 1 (MCP-1), transforming growth factor alpha (TGF-α), interleukin 6 (IL-6) and hypoxia inducible factor 1 alpha (HIF-1α) were detected by enzyme linked immunosorbent assay (ELISA) in all groups. Spearman correlation analysis was used to analyze the correlation between serum oxidative stress indicators and traditional risk factors of tubular atrophy/renal interstitial fibrosis. Multivariable linear regression analysis was used to analyze the correlation between oxidative stress indicators and degree of renal tubular atrophy/renal interstitial fibrosis. Results There were differences in serum levels of AOPPs, MDA, SOD, CAT and GSH-Px in IgAN patients with different degrees of renal interstitial fibrosis (all P﹤0.05). With the increase of renal interstitial fibrosis, the levels of AOPPs and MDA increased gradually, while the levels of SOD, CAT and GSH-Px decreased gradually. Serum AOPPs, MDA, SOD, CAT, GSH-Px concentration in IgAN patients were correlated with the mean arterial pressure (MAP), total blood protein (TP), albumin (Alb), Scr, uric acid (UA), 24-hour urinary protein volume and estimated glomerular filtration rate (eGFR). Multivariate regression analysis showed that the AOPPs levels of blood were positively correlated with MAP, Scr, UA and 24-hour urinary protein (all P﹤0.01), and negatively correlated with TP, Alb, eGFR (all P﹤0.05). The serum levels of AOPPs and MDA in IgAN patients were positively correlated with the levels of TGF-β1, MCP-1, TGF-α, IL-6 and HIF-1α. The levels of SOD, CAT and GSH-Px were negatively correlated with the levels of TGF-β1, MCP-1, TGF-α, IL-6 and HIF-1α. Multivariate stepwise regression analysis showed that the degree of renal interstitial fibrosis in IgAN patients was positively correlated with serum AOPPs level (β=0.285, P=0.001), negatively correlated with CAT (β=-0.346, P﹤0.001), GSH-Px (β=-0.303, P﹤0.001). Conclusions The level of serum oxidative stress in IgAN patients is elevated and positively correlated with the degree of renal interstitial fibrosis, suggesting that oxidative stress may be involved in the occurrence and development of renal interstitial fibrosis.     

Related factors of hyperuricemia in IgA nephropathy patients

Objective To investigate the influencing factors of hyperuricemia in patients with IgA nephropathy (IgAN). Methods A retrospective study was performed in patients with renal biopsy diagnosed as IgAN in the Department of Nephrology, Provincial Hospital of Anhui Medical University from January 2016 to October 2018. According to the blood uric acid level, they were divided into two groups: patients with hyperuricemia and patients without hyperuricemia. The general clinical indicators and renal pathological data were compared between the two groups. Logistic regression model was used to analyze the influencing factors of hyperuricemia in IgAN patients. Results A total of 125 IgAN patients with age of (35.70±11.16) years old were enrolled, including 63 males and 62 females. The morbidity of hyperuricemia was 44.0%(55/125). Compared with the normal blood uric acid group, the blood urea nitrogen, serum creatinine and the proportion of chronic kidney disease (CKD) stage 3-5, small arterial wall thickening, fibrous crescents/globules, renal interstitial fibrosis, renal tubular atrophy, glomerular sclerosis and inflammatory cell infiltration in the hyperuric acid group were higher, while the level of estimated glomerular filtration rate (eGFR) was lower. And the differences were statistically significant (all P＜0.05). Multivariate logistic regression analysis showed that the level of serum creatinine was an independent related factor of hyperuricemia in IgAN patients (OR=1.034, 95%CI 1.005-1.064, P=0.021). Conclusions IgAN patients with hyperuricemia presented more severe glomerular, tubular and interstitial lesions, and the level of serum creatinine is an independent related factor of hyperuricemia in IgAN patients. High uric acid level may have an important influence on the progression of IgAN, so good control of serum uric acid may improve the prognosis of patients with IgAN.     

The association of WISP-1 expression in IgA nephropathy patients with renal interstitial fibrosis

Objective To investigate the relationship between the expression of Wnt induced secreted protein-1 (WISP-1) and the fibrosis of renal biopsy tissue in IgA nephropathy (IgAN) patients. Methods Fifty-three patients firstly diagnosed as IgA nephropathy by renal biopsy were included and classified according to Oxford and Lee's classification. Sixteen patients with MCD entered the fibrosis negative control group, and fourteen healthy adults entered the normal control group. The expression of WISP-1 in renal tissues and serum of all subjects were detected by immunohistochemistry and ELISA respectively. Results Immunohistochemistry results showed that WISP-1 was not expressed in MCD patients and normal human kidney tissues, which was abundantly deposited in renal tissue of patients with focal proliferative IgAN with renal interstitial fibrosis. The serum level of WISP-1 in IgAN patients was significantly higher than that in normal subjects (P=0.015) and MCD patients (P=0.030). In the subgroup analysis of IgAN renal fibrosis, the serum concentration of WISP-1 of fibrosis grade between 0-10% (F1 group) and fibrosis＞25% (F3 group) were significantly higher than that in the normal group and the MCD group (all P＜0.05). There was no significant difference between F2 group (10%＜fibrosis≤25%) and normal group or MCD group (P＞0.05). Conclusions The expression of WISP-1 in serum and renal tissue of renal interstitial fibrosis IgAN patients is higher than that of normal and MCD patients without renal fibrosis, and the IgAN patients' serum level of WISP-1 is significantly increased in fibrosis lower score group. The expressions of WISP-1 in serum and renal tissue are related to the occurrence of IgAN renal interstitial fibrosis, in which WISP-1 may play an important role as an early precursor factor in the pathogenesis of IgAN renal interstitial fibrosis.     

Clinical and pathological outcomes of crescentic IgA nephropathy and Henoch-Schonlein purpura nephritis

Objective To evaluate the clinicopathological characteristics and long-term outcomes of crescentic IgA nephropathy (crescentic IgAN) and Henoch-Schonlein purpura nephritis (crescentic HSPN). Methods Patients who were diagnosed with crescentic IgAN and crescentic HSPN through renal biopsy in Peking University First Hospital from 1998 to 2015 were enrolled and retrospectively analyzed. They were defined as ≥50% crescentic glomeruli on kidney biopsy-one of the common causes of rapidly progressive glomerulonephritis. The primary outcome was end-stage renal disease (ESRD) and all-causes death. Multivariate COX regression was used to analyze the risk factors for prognosis. A prediction model was developed by Logistic curve. Results One hundred and forty nine patients, including 127 cases of crescentic IgAN and 22 cases of crescentic HSPN, were included. Their mean age was 36 years old and 61.7% were men. The median proteinuria was 4.4 (2.8, 6.9) g/d, serum creatinine (Scr) 294 (152, 615) μmol/L and percentage of crescents was 64.3% (55.6% to 78.0%). There were no significant differences between crescentic IgAN and HSPN (all P＞0.05) regarding above characteristics. A total of 113 patients (75.8%) entered the follow-up cohort, including 97 patients with IgAN and 16 with HSPN. After a median follow-up of 36 months (range 6 to 189), 62 (54.9%) patients progressed to ESRD or death. After adjusting initial Scr, renal survival showed no difference between these two groups (P=0.865). In a multivariate Cox regression model, initial Scr (HR=1.002, 95%CI 1.001-1.003, P＜0.001) and tubular atrophy/interstitial fibrosis ＞50% (HR=2.986, 95%CI 1.046-8.530, P=0.041) were the independent risk factors for ESRD. Cumulative probability of ESRD prediction model was P=exp(-3.166+0.655×Scr)/[1+exp(-3.166+0.655×Scr)] with sigmoid curve. Patients with Scr≥570 μmol/L were difficult to recover from dialysis, which was identified as a non-return point. This non-return point increased to 725 μmol/L when plasma exchange therapy was added. Conclusions Crescentic HSPN and IgAN have similar clinical-pathological characters and outcomes with poor prognosis. Initial Scr and tubular atrophy/interstitial fibrosis are the independent risk factors affecting prognosis. The prediction model based on Scr is established and the non-return point is identified.     

Analysis of the clinical pathological characteristics and prognosis of primary IgA nephropathy with hypertension

Objective To investigate the clinic-pathological features and prognostic risk factors of IgA nephropathy (IgAN) with hypertension (HTN). Methods Primary IgAN patients diagnosed with biopsy from January 2016 to December 2017 were recruited. Patients were divided into IgAN with normal blood pressure (IgAN-NTN) group and IgAN with hypertension (IgAN-HTN) group based on the pressure value when performing the kidney biopsy. The clinical and pathological data were collected and compared between the two groups. Kaplan-Meier method was conducted for renal results, whereas the Cox regression model was exploited to analyze the prognostic factors in the progression of IgAN-HTN patients. Results The total number of enrolled patients was 275 cases, 170 (61.82%) of which had normal pressure and 105 individuals (38.18%) resulted in hypertension. The IgAN-HTN group in terms of male proportion, age, systolic pressure, diastolic pressure, serum urea nitrogen, serum creatinine, serum uric acid, 24 h urinary protein, triacylglycerol, complement C4 and so on were higher than those in the IgAN-NTN group (all P＜0.05). The incidence of gross hematuria and the level of estimated glomerular filtration rate (eGFR) were significantly lower than those in the NTN group (all P＜0.001). For the aspect of light microscope pathological manifestations, IgAN-HTN group exhibited more severe histological lesions including glomerular sclerosis, renal tubular atrophy or renal interstitial fibrosis, interstitial vascular injury than IgAN-NTN group (all P＜0.05). Immunofluorescence examination results showed that the deposition ratio of C1q in IgAN-HTN group was higher than that in IgAN-NTN group (P=0.015). By employing Kaplan-Meier method, the cumulative renal survival rate in the HTN group was much lower than that in the NTN group (Log-rank test: χ2=6.456, P=0.011). For the patients in IgAN-HTN group, the cumulative renal survival rate in the dyslipidemia group was much lower than that in the ortholiposis group (Log-rank test: χ2=5.093, P=0.024). There was no significant difference in the cumulative renal survival rate between the blood pressure control group and the unqualified group (Log-rank test: χ2=1.036, P=0.309). As a result of univariate and multivariable Cox regression analysis, total cholesterol, eGFR and 24 h urinary protein were risk factors for renal progression of IgAN patients with hypertension. Conclusions The clinical manifestations and renal pathological changes in patients with IgAN-HTN are more serious than those in IgAN-NTN patients, which result in worse prognosis. IgAN-HTN patients should be paid more attention to the management of serum lipid level during treatment and follow-up.     

维持性血液透析患者血氨基末端脑钠肽前体水平与肾性贫血的相关性

目的探讨维持性血液透析(MHD)患者发生肾性贫血的危险因素,分析其与血氨基末端脑钠肽前体(NT⁃proBNP)的相关关系。方法选取2018年8月至2018年11月期间在复旦大学附属华山医院接受MHD 3个月以上、病情稳定的患者为研究对象。按照血红蛋白(Hb)水平分为贫血组和非贫血组。回顾性收集患者一般资料、观察期内实验室检查及透析相关资料。Pearson相关分析法分析贫血指标与透析相关指标、血NT⁃proBNP水平的相关性;逐步多元线性回归法分析MHD患者发生贫血的危险因素。结果共160例MHD患者入选本研究,年龄(63.11±11.35)岁,男79例(49.4%),女81例(50.6%)。患者透析龄(118.01±82.32)个月,血红蛋白(110.09±13.48)g/L,NT⁃proBNP水平中位数为3985 ng/L。贫血组73例(45.6%),非贫血组87例(54.4%),贫血组血NT⁃proBNP水平显著高于非贫血组(t=-3.714,P<0.001)。MHD患者血红蛋白水平与每周透析时间(r=0.228)和血白蛋白(r=0.349)呈正相关,与血NT⁃proBNP水平呈负相关(r=-0.318);血细胞比容与每周透析时间(r=0.283)、血清钙(r=0.317)、血磷(r=0.264)、白蛋白(r=0.513)呈正相关(均P<0.05)。逐步多元线性回归分析结果显示,低血白蛋白、高NT⁃proBNP水平是MHD患者发生肾性贫血的独立危险因素。结论MHD患者NT⁃proBNP水平升高与血红蛋白水平降低相关,低血白蛋白、高NT⁃proBNP是MHD患者发生贫血的危险因素。提示肾性贫血的治疗需要考虑改善营养不良和高容量等因素。     

Clinical and pathological features of IgA nephropathy with macrohematuria in history

Objective To investigate the clinical and pathological characteristics of IgA nephropathy (IgAN) with macrohematuria (MH). Method 1512 consecutive patients with biopsy-proven IgAN diagnosed from January 2006 to December 2011 were enrolled, and divided into MH group and control group respectively, according to whether there existed episodes of MH before renal biopsy. The clinical and pathological characteristics were compared between two groups. Patients in MH group were then divided into three groups according to the interval from the last episode of MH to renal biopsy to clarify the concomitant clinicopathological changes associated with occurrence of MH. Results The rate of MH in history was 22.1%. MH group patients had significantly lower serum creatinine, slighter proteinuria, lower prevalence of hypertension and heavier microhematuria than control group (all P＜0.001). The prebiopsy durations were similar in two groups (P=0.627). In MH group, chronic pathological indicators, including global/segmental sclerosis, tubule atrophy/interstitial fibrosis were all slighter (all P＜0.001), whereas activity indicators, including necrosis lesions, crescents and mesangial proliferation were all more severe compared with control group (all P＜0.05). Those who underwent renal biopsy within 30 days of the last episode of MH had more severe proteinuria and microhematuria, higher prevalence of necrosis lesions, more severe crescents formation, and endothelial proliferation (all P＜0.05). Conclusions IgAN patients with MH in history have relatively milder clinical and chronic pathological manifestations, however more active pathological changes especially in those who suffer episode of MH recently.