IgA肾病合并高尿酸血症患儿的临床病理分析

目的：探讨IgA肾病合并高尿酸血症患儿的临床及病理变化的特点。方法：回顾性分析我院2006年1月～2010年12月经肾活检确诊的67例IgA肾病患儿的临床病理资料,根据血尿酸水平分为高尿酸组（n=17）和正常尿酸组（n=50）,比较两组的临床病理特点。结果：高尿酸组血肌酐及三酰甘油高于正常尿酸组（P〈0.05）。两组间尿蛋白、总胆固醇、高密度脂蛋白、低密度脂蛋白、载脂蛋白A1、载脂蛋白B、脂蛋白a,差异均无统计学意义。高尿酸组肾脏病理改变以Ⅲ级为主,而正常尿酸组以Ⅱ级为主,高尿酸组Ⅳ级、Ⅴ级病变较正常尿酸组多见,正常尿酸组Ⅰ级病变较高尿酸组多见,两组间肾损害程度差异具有统计学意义（P〈0.01）。高尿酸组和正常尿酸组肾内动脉病变表现为小动脉管壁增厚,两组间的差异无统计学意义。结论：IgA肾病患儿高尿酸血症与高三酰甘油和肾功能降低密切关联。合并高尿酸血症的IgA肾病患儿,其病理损伤程度较血尿酸正常的IgA肾病患儿严重,高尿酸血症亦为影响小儿IgA肾病进展及预后的重要危险因素。     

IgA肾病合并高尿酸血症患者的临床病理分析

目的探讨IgA肾病合并高尿酸血症患者的临床及病理变化的特点,以期揭示IgA肾病伴有高尿酸血症的临床意义。方法回顾性分析2006年6月至2012年12月厦门大学附属中山医院肾内科收治的270例经肾活检确诊的原发性IgA肾病患者,依据血尿酸水平,将270例IgA肾病患者分为高尿酸血症组和尿酸正常组,测定记录所有患者的性别、发病年龄、收缩期血压、24 h尿蛋白定量、血尿酸、血肌酐、血白蛋白、血脂等临床指标,所有患者均进行肾脏病理检查并行Lee分级,统计分析2组的临床和病理特点,并对肾功能正常患者(135例)的病理指标进一步行亚组分析。结果IgA肾病患者高尿酸血症的患病率为25.19%,高尿酸血症组患者年龄、血白蛋白、血三酰甘油、血清总胆固醇水平与尿酸正常组比较,差异无统计学意义,患者男性比例、收缩期血压、24 h尿蛋白定量、血肌酐水平均高于尿酸正常组(P0.05),高尿酸血症组患者肾脏病理Lee分级严重的比例及发生肾小管间质病变、肾内动脉病变的比例均高于尿酸正常组(P0.05)。正常肾功能患者中,高尿酸血症组出现动脉壁肥厚等肾内动脉病变及肾小管间质慢性病变的比例亦高于尿酸正常组(P0.05)。结论 IgA肾病合并高尿酸血症患者与尿酸正常组患者比较,临床表现及肾脏病理损伤多较重,尤其对肾小管间质病变及肾内血管病变影响更明显,临床预后不佳,应予重视并及时有效地进行干预治疗。     

伴高尿酸血症IgA肾病的临床、病理特点及预后的相关分析

目的：研究伴高尿酸血症IgA肾病患者的临床、病理特点及预后的相关因素。方法：对2006年～2009年经肾活检确诊为IgA肾病的72例患者的临床与病理资料进行分析。根据血尿酸水平,将72例IgA患者分为高尿酸血症组与血尿酸正常组,比较两组间临床指标、肾功能指标及病理学参数。结果：临床指标中年龄、血尿酸及尿蛋白定量均与血肌酐、肾小球滤过率有显著相关性（P〈0.05）。多元逐步回归分析血尿酸对IgA肾病肾功能进展的预测优于尿蛋白定量。病理参数中肾小球积分、肾小管间质积分与血肌酐、肾小球滤过率显著相关（P〈0.05）。高尿酸血症组肾功能指标均差于血尿酸正常组。高尿酸血症组肾小管间质损害均高于血尿酸正常组。结论：IgA肾病的预后主要与尿蛋白定量、血尿酸、肾小管间质损害、球性硬化有关,IgA肾病37.5%患者合并高尿酸血症、其临床尿蛋白、肾功能损害及病理肾小管间质损害均高于血尿酸正常组IgA肾病患者,应重视血尿酸在IgA肾病中的作用。     

IgA肾病伴高尿酸血症的临床、病理特点及相关因素分析

目的分析IgA肾病伴高尿酸血症患者的临床指标与病理改变的特点,探讨其相关影响因素。方法回顾性选取2015年1月1日至2019年12月31日于新疆维吾尔自治区人民医院首次肾活检并明确诊断为原发性IgA肾病的患者共320例作为研究对象,根据其血尿酸水平分为高尿酸血症组(111例)及血尿酸正常组(209例),比较两组患者在临床与病理指标方面的差别,采用Logistic回归模型分析IgA肾病伴高尿酸血症患者的相关影响因素。结果 320例IgA肾病患者中,合并高尿酸血症者占34.7%。临床指标方面,高尿酸血症组在男性患者比例、收缩压、舒张压、尿酸、血红蛋白、三酰甘油、尿素氮、肌酐、24 h尿蛋白定量上比血尿酸正常组高(P0.05),而高密度脂蛋白、估算肾小球滤过率比血尿酸正常组低(P0.05)。病理改变方面,高尿酸血症组在节段性肾小球硬化/黏连比例、肾小管萎缩/间质纤维化25%比例上大于血尿酸正常组(P0.05);进一步组间两两比较得出肾小管萎缩/间质纤维化50%组的比例较肾小管萎缩/间质纤维化组25%组及介于26%～50%组的比例大(P0.05)。相关因素分析得出,估算肾小球滤过率是IgA肾病伴高尿酸血症的独立相关因素(P0.05)。结论 IgA肾病伴高尿酸血症患者在临床指标及病理改变方面均较血尿酸正常患者重,提示高尿酸血症可能与IgA肾病病情进展及预后不良有一定的相关性,综合控制尿酸、血压、血脂等水平有助于改善患者预后。     

^99mTc—DTPA肾动态显像在IgA肾病慢性肾功能不全患者的临床应用

目的探讨^99mTc-DTPA肾动态显像在IgA肾病（kAN）慢性肾功能不全患者病情监测及预后判断时的应用价值。方法23例经肾活检确诊为IgAN的患者行常规^99mTc-DTPA肾动态显像，测定肾小球滤过率（GFR，包括总GFR和分肾GFR），同时行肾活检按Lee氏分级标准将肾脏病理改变分级，Katafuchi积分标准对患者的肾脏病理损害，包括肾小球损害、肾小管间质损害和血管损害进行积分，将积分与上述显像指标（GFR）进行相关分析。结果随着病理分级增高，GFR趋于降低，各级组间比较差异有显著性意义（P〈0．05或P〈0．01）；相关分析示GFR与肾脏病理总积分、肾小球损害（尤其是节段损害和全球硬化）、小管间质（尤其是间质纤维化和肾小管萎缩）及血管损害呈负相关（P〈0．05或P〈0．01）；在临床指标方面，GFR与血清肌酐和尿蛋白定量及血压（收缩压和舒张压）呈负相关（P〈0．05或P〈0．01）。结论通过^99mTc-DTPA肾动态显像获得的GFR与IgA肾病肾脏病理学改变及临床指标关系密切，其在IgA肾病患者病情监测、指导治疗及预后判断中具有重要临床应用价值。     

体外循环直视心脏手术后高尿酸血症的临床探讨

目的探讨体外循环直视心脏手术后高尿酸血症的发生率、危险因素及其对病人预后的影响.方法收集2002年4月至2004年10月应用体外循环的心脏手术病人232例,根据术后24h血尿酸的水平以及肾脏的损害分为无高尿酸血症组、高尿酸血症组和急性尿酸盐肾病组,对病人高尿酸血症的发生率、危险因素及病人的预后进行分析比较.结果术后24h发生高尿酸血症70例（30.1%）,急性尿酸盐肾病22例（9.5%）.无高尿酸血症组死亡1例（0.7%）,高尿酸血症组死亡1例（1.4%）,急性尿酸盐肾病组死亡3例（13.6%）（P＜0.001）.急性尿酸盐肾病组病人年龄明显小于无高尿酸血症组和高尿酸血症组,3组病例比较血糖、血肌酐、总胆红素、结合胆红素、非结合胆红素差异无统计学意义.3组间体外循环时间、平均动脉压,差异有统计学意义（P＜0.01）.进一步相关分析发现体外循环时间长、术后高胆红素血症及低血压,可能是术后血尿酸增高的危险因素.结论心脏手术后高尿酸血症常见,其发生可能与低龄、体外循环时间延长、溶血及低血压有关.血尿酸持续升高导致急性尿酸盐肾病对病人预后不利.     

原发性IgA肾病与非IgA系膜增生性肾小球肾炎的临床病理分析

目的 比较原发性IgA肾病与非IgA系膜增生性肾小球肾炎（non-IgA mesangial proliferative glomerulonephritis,non-IgA MsPGN）的临床及肾脏病理改变特点.方法 选择我科经肾活检确诊的原发性IgA肾病患者（A组）和non-IgA MsPGN患者（B组）进行临床与病理资料对比分析.结果 A、B组的性别、前驱上呼吸道感染诱因、起病时伴发高血压、镜下血尿、血肌酐无统计学差异（P＞0.05）.B组较A组起病年龄小,起病时伴发肉眼血尿比率低,肾病综合征发生率高,血IgG水平低,差异均有统计学意义（P＜0.05）.A组肾小球、肾小管间质、肾小动脉病理改变发生率高于B组（P＜0.05）,IgM、C3沉积、系膜区电子致密物沉积、大块状致密物、足细胞微绒毛化、肾小球基底膜分层发生率均较B组高（P＜0.01）.结论 IgA肾病与non-IgA MsPGN在临床表现、病理改变上存在明显差异,IgA肾病较non-IgA MsPGN病理损伤重.     

不同性别对进展性IgA肾病患者合并高尿酸血症的研究

目的:观察不同性别和尿酸水平进展性Ig A肾病中对疾病的影响。方法:回顾性分析2008年1月~2014年12月,诊断为Ig A肾病LEEⅢ级及以上且尿蛋白1 g的患者110例。根据性别和血尿酸水平分组,观察各因素对患者进入终点事件的影响。结果:男性高尿酸组较正常组,年龄、e GFR、进入终点事件差异无统计学意义(P0.05);女性高尿酸组较正常组e GFR下降幅度大,差异有统计学意义(P0.05);高尿酸组e GFR变化率,女性较男性下降幅度大,差异有统计学意义(P0.05);女性患者中,高尿酸组进入终点事件显著增多(χ2=8.952,P=0.003)。结论:进展性Ig A肾病患者中,高尿酸血症可导致更严重肾功能损害,在不同性别中有差异。     

IgA肾病合并高尿酸血症患者临床及病理特点分析

目的:探讨IgA肾病合并高尿酸血症分发病率及临床和病理特点。方法:将经过肾活检明确诊断的原发性IgA肾病132例患者按着尿酸水平和血肌酐水平进行分组,比较其临床特点及病理特点差异。结果:高尿酸血症在CKD3期及以上的患病率显著高于CKD1期及CKD2期的患病率。高尿酸血症组的患者较尿酸正常组高血压发生率,24 h尿蛋白定量,血清胆固醇水平,以及BMI水平显著升高,其Lee氏分级主要表现为Ⅲ级,随着Lee氏分级的加重,高尿酸血症的患病率明显增加。高血尿酸组患者肾脏病理球性硬化,肾小管间质积分、血管病变积分,肾小管萎缩均高于非高尿酸组。在CKD3期及以上患者的亚组中,高尿酸血症患者的临床表现及病理表现更为严重。结论:IgA肾病合并高尿酸血症的患者,在肾小球滤过率下降的患者中间发病率更高,其临床和病理损伤均重于尿酸正常的IgA肾病患者。     

GNB3 C825T等位基因多态性与原发性IgA肾病相关性研究

目的：研究G蛋白β3亚基（GNB3）C825T等位基因多态性与原发性IgA肾病（IgAN）的发生与病情进展。方法：病例组为216例原发性IgAN患者,对照组为200例健康志愿者。采用聚合酶链式反应-限制性片段长度多态性（PCR-RFLP）技术检测各组GNB3 825位点基因型。病例组分为高血压组与非高血压组;同时按基因型的不同将病例组分为TT组、CT组与CC组。结果：（1）病例组与对照组TT、CT、CC基因型频率分别为21.76%、54.63%、23.61%与18.00%、47.00%、35.00%,两组TT、TC、TT＋TC基因型与CC基因型分布频率存在统计学差异（P〈0.05）;病例组T等位基因分布频率高于对照组（49.07%vs 41.50%,P〈0.05）。（2）216例IgAN中,高血压组与非高血压组TT、CT、CC基因型频率分别为32.88%、49.31%、17.81%与16.09%、57.34%、26.57%（P〈0.05）。高血压组T等位基因频率较非高血压组明显增加（57.53%vs 44.76%,P〈0.05）。（3）病例组不同基因型携带者病理分级轻重无统计学差异（P〉0.05）。（4）病例组中不同基因型携带者在性别、年龄、体重指数、尿蛋白排泄量（〉1 g/d）、血肌酐水平、血胆固醇水平及三酰甘油水平无统计学差异（P〉0.05）,而高尿酸血症的发生存在统计学差异（P〈0.05）,TT组高尿酸血症患者较CT组及CC组高。结论：（1）病例组TT基因型和T等位基因频率较对照组明显增加,结果显示GNB3 825T等位基因可能与IgA肾病的发病有关,提示该基因可能与IgA肾病的遗传易感性相关。（2）GNB3 825T等位基因能影响IgA肾病患者高血压、高尿酸血症的发生。GNB3C825T等位基因多态性与IgA肾病发病及病情进展的相关机制有待进一步研究。     

IgA肾病患者扁桃体B1a细胞和IgA1阳性细胞表达及相关因素分析

目的 研究B1a和IgA1阳性细胞在IgA肾病患者扁桃体中的表达及B1a细胞与血尿、蛋白尿和病理Lee分级的关系。 方法 肾活检确诊为原发性IgA肾病及非肾炎慢性扁桃体炎患者各8例为对象,用免疫荧光法和激光共聚焦显微镜对其扁桃体组织进行B1a及IgA1细胞定位和定量计算,并按蛋白尿程度和Lee分级标准与IgA肾病组B1a细胞数量行统计学分析。 结果 B1a细胞主要分布在扁桃体生发中心和小结帽;IgA1细胞主要分布在上皮内、上皮下,以上皮和淋巴组织交界区为多。与慢性扁桃体炎组比较,IgA肾病组两种细胞表达明显增多（P < 0.01）,且呈正相关（r = 0.778,P = 0.023）。在血尿伴蛋白尿和Lee≥Ⅲ级组B1a细胞显著高于单纯血尿和Lee<Ⅲ级组（P < 0.05）。 结论 IgA肾病患者扁桃体中IgA1可能是B1a细胞分泌的。B1a细胞数量随着患者蛋白尿的出现和病理严重程度的加重而增加,可能在疾病发生和进展过程中起着重要的作用。     

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.     

儿童无症状尿检异常IgA肾病的临床病理和预后分析

目的 探讨儿童无症状尿检异常的IgA肾病的临床病理特征和预后。 方法 对54例IgA肾病儿童的临床和病理特征进行分析。根据起病时有无临床症状分为无症状尿检异常组和有症状肾炎组。组织病理学分级参照Lee氏和Katafuchi氏半定量积分法。 结果 无症状尿检异常组18例，有症状肾炎组36例。有症状肾炎组尿蛋白量（24 h）明显高于无症状尿检异常组[（2.3±2.2） g比（0.4±0.3） g，P < 0.05]。无症状尿检异常的IgA肾病儿童表现为镜下血尿者，87％有尿微量白蛋白增高。无症状尿检异常IgA肾病患儿病理表现以Lee 氏Ⅰ~Ⅱ级为主，2例表现为Lee氏Ⅳ~Ⅴ级和 5例发生Katafuchi Ⅱ~Ⅲ级肾小管间质病变。有症状肾炎组Lee氏病理分级以Ⅱ~Ⅲ级为主，两者病理分级分布差异无统计学意义（P > 0.05）。全组患儿平均随访（26.9±8.8）月后，1例病理为Lee 氏Ⅴ级患儿进入终末期肾衰竭，其余患儿Scr均无升高1倍以上。 结论 无症状尿检异常的儿童IgA肾病虽临床症状轻微，但可出现病理损害严重的病例，并影响其预后。     

IgA Nephropathy Associated with Thin Basement Membrane with or without Inflammatory Disease: Getting a Different Prognosis?

Background. Thin basement membrane nephropathy (TBMN) patients with additional inflammatory diseases and IgA nephropathy (IgAN) have not been reported before. It was unclear that if the prognosis of these patients is better or worse than patients with IgAN and TBMN, or IgAN patients with normal glomerular basement membrane (GBM). Methods. We first reported five TBMN patients with additional inflammatory diseases and IgAN: three were with rheumatoid arthritis, and two had Crohn's disease. Clinical and laboratory features were analyzed between this group (group 3), IgAN patients with normal GBM (group 1), and patients with TBMN and IgAN (group 2). Results. Significant differences were observed in serum levels of IgG, IgA, and IgM between groups 1 and 3, p < 0.001, and between groups 2 and 3, p < 0.001. Glomerular filtration rate (GFR) in group 3 was significantly lower than that of groups 1 and 2, p < 0.01, respectively. Conclusion. The prognosis of these patients is worse than patients with IgAN and TBMN or IgAN patients with normal GBM. Serum immunoglobulin levels and GFR in these patients were different from patients with IgAN and TBMN, or IgAN patients with normal GBM.     

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。     

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。     

Mesangial C3 deposition and decreased serum C3levels in patients with IgA nephropathy

Objective To explore theclinical significance of complementactivation in IgA nephropathy (IgAN) patients and provide new potential therapy targets. Methods Biopsy-proven IgAN patients admitted in our renal center were retrospectively recruited. Demographic, baseline clinical and pathological data were recorded as well as the follow-up results. Patients were divided into three groups, negative, weak positive and strong positive group, according to the intensity of C3 deposition in mesangial area of glomurili. Decreased serum C3 level was defined as C3＜85 mg/dl. Results In this study, 528 IgAN patients were recruited and meanfollow-up time was3 years. There were 119 (22.5%), 164(31.1%), 245(46.4%) patients in the negative, weak positive and strong positive group respectively; 93(21.7%) patients had decreased serum C3 level and 335(78.3%) patients had normal serum C3 level; Significant negative correlation was found between mesangial area of C3 deposition and serum level of C3(r＝-0.209, P＜0.01). Theage or sex were similar among different groups of mesangial C3 deposition. In univariate analysis, higher baselineserum creatinine,uric acid and IgAlevels, and lower estimated glomerular filtration rate(eGFR), body mass index (BMI) levels were associated with a higher grade of mesangial C3 deposition (P＜0.05). Endocapillary hypercellularity and tubular atrophy or interstitial fibrosis were more prominent in patients with higher grade mesangial deposition of C3. Compared with the patients with normal serum C3 level, patients with decreased serum C3 level had lowerwhite blood cells,hemoglobin,triglyceride, cholesterol, eGFR level and higher serum creatinine level(P＜0.05). During the follow-up,a total of 54 patients developed to end stage renal disease (ESRD), the incidence of ESRD was 23.7% in patients with decreased serum C3 level and 8.4% with normal C3 level.Kaplan-Meieranalysis showed that median outcome-free survival timeof patients with decreased serum C3 levelwas significantshorter than patients with normal serum C3 level [(145.0±22.5) months vs (150.8±17.0) months, P＜0.01]. Cox regression proportional hazards models showed that after adjusting by sex, ageand clinical indicators (MAP, eGFR, serum albumin, urine protein and hemoglobin level), decreased serum C3level (HR＝0.97, 95%CI 0.96, 0.99, P＜0.01) remained be an independent riskfactor of ESRD. Conclusions There are different levels of complement activation in patients with IgAN. Complement activation is associated with baseline renal function and clinical outcomes, and decreased serum C3level is an independent riskfactor of ESRD in IgAN patients. Complement activation may be involved in the progression of IgAN.     

Clinicopathological features and outcomes of primary IgA nephropathy patients with chronic tonsillitis

Objective To explore the clinicopathological features and renal outcomes of primary IgA nephropathy (IgAN) patients with chronic tonsillitis. Methods Patients with biopsy-proven primary IgAN admitted to The First Affiliated Hospital, Sun Yat-sen University from January 2006 to December 2011 were enrolled. The clinicopathological features and renal outcomes of patients with and without chronic tonsillitis were retrospectively compared. The primary outcome was progression to end stage renal diseases and/or doubling of serum creatinine. Results A total of 981 primary IgAN patients were enrolled and 98 patients (9.99%) had a history of chronic tonsillitis. Compared with patients without chronic tonsillitis, IgAN patients with chronic tonsillitis exhibited significantly higher prevalence of acute episodes of tonsillitis as a predisposition (P＜0.001), higher serum IgA levels (P=0.012), and higher prevalence of macrohematuria (P=0.006). No significant difference in renal pathological features was observed in patients with and without chronic tonsillitis. Moreover, the renal outcomes were similar as regards IgAN patients with and without chronic tonsillitis. Conclusion IgAN patients with chronic tonsillitis had higher prevalence of acute episodes of tonsillitis and macrohematuria as well as higher serum IgA levels. However, IgAN patients with and without chronic tonsillitis showed no significant difference in renal pathological features and renal outcomes.     

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.     

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.