Correlation analysis of clinical parameters and prognosis in different pathological grades of primary IgA nephropathy

Objective To explore the correlation between different pathological grading methods and clinical parameters of primary IgA nephropathy and predicate the prognosis. Methods Case data were collected for 185 patients with primary IgA nephropathy and followed up for over 12 months to compare the correlation of clinical parameters with Oxford,Lee and Hass classifications. Results The differences of mesangial cell hyperplasia(M),endothelial cell hyperplasia(E),segmental sclerosis of ball/adhesion(S),renal tubular atrophy/fibrosis(T),crescent formation(C) in Oxford,Lee and Hass classifications and serum creatinine(Scr),24 hours urinary protein quantitative(24h-UP) and estimated glomerular filtration rate(eGFR) were statistically significant(P<0.05);The differences of M/S/T in Oxford classification and serum uric acid(UA) were statistically significant(P<0.05). Statistically significant differences existed between T of Oxford classification,Lee grade and mean arterial pressure(MAP) (P<0.05). The negative correlation between T of Oxford type and eGFR was the strongest(r=-0.558,P<0.001). And the positive correlation between T of Oxford type and urea nitrogen(BUN),Scr and UA was the strongest(r=0.424,r=0.554,r=0.407,P<0.001,P<0.001,P<0.001). The strongest negative correlation existed between Lee classification and hemoglobin(Hb),albumin(Alb) (r=-0.217,r=-0.367,P=0.003、P<0.001) and the strongest positive correlation existed between Lee classification and 24h-UP,MAP(r=0.312,r=0.202,P<0.001,P=0.006). No significant difference existed in renal cumulative survival rate among Oxford grade M,E and S groups(P>0.05);renal cumulative survival rate of T2 group was lower than that of T0/T1 group(P<0.05);renal cumulative survival rate of C2 group was lower than that of C0/C1 group(P<0.05). No significant difference existed in cumulative renal survival rate between Lee grade and Hass grade I/Ⅱ/Ⅲ(P>0.05). However,cumulative renal survival rate of grade IV/V was lower than that of grade I/I/Ⅲ(P<0.05). Conclusion The pathological grade of primary IgA nephropathy is correlated with clinical parameters. Oxford T classification has the strongest clinical applicability in the evaluation of renal function changes. Lee classification is more suitable for IgA nephropathy patients with IgA nephropathy accompanied by elevated blood pressure,anemia,decreased albumin and proteinuria. The prognosis of patients with tubular atrophy or interstitial fibrosis >50%,crescent formation >25%,Lee grade and Hass grade IV/V are poor.