Clinicopathological characteristics and prognosis of non-hypertensive IgA nephropathy patients with microangiopathy lesions
10.3760/cma.j.cn441217-20191014-00051
- VernacularTitle: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
- Author:
Jingyi LI
1
;
Qingqing CAI
;
Sufang SHI
;
Lijun LIU
;
Xujie ZHOU
;
Suxia WANG
;
Xiaojuan YU
;
Jicheng LYU
;
Hong ZHANG
Author Information
1. 北京大学第一医院肾内科 北京大学肾脏病研究所 卫生部肾脏疾病重点实验室 教育部慢性肾脏病防治重点实验室，北京 100034
- From:
Chinese Journal of Nephrology
2020;36(4):257-263
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the clinicopathological characteristics and prognosis of IgA nephropathy (IgAN) patients with microangiopathy lesions and with no hypertension.Methods:Adult IgAN patients without hypertension were selected from Peking University First Hospital. All kidney biopsies were independently reviewed by 2 investigators. Patients were divided into three groups (microangiopathy group, simple arterio/arteriolosclerosis group and normal vascular group) by renal arteriolar lesions. Composite kidney end point event defined as a ≥30% reduction in estimated glomerular filtration rate (eGFR) and end-stage kidney disease. Cox regression analysis was used to test the association between microangiopathy lesions and the outcomes.Results:A total of 420 patients were included in this study, of which 37(8.8%) patients had renal arteriolar microangiopathy lesions, 134 (31.9%) patients had simple arterio/ arteriolosclerosis, and the others had no vascular lesion. Compared with simple arterio/arteriolosclerosis group or non-vascular lesion group, patients with renal arteriolar microangiopathy lesions had more severe urine protein ( P=0.002), worse renal function ( P<0.001), higher proportion of segmental glomerulosclerosis and/or balloon adhesion (S1), tubular atrophy/interstitial fibrosis (T1/2), cellular/fibrocellular crescents (C1/2) (all P<0.05). During the follow-up, 20(54.1%) patients with microangiopathy lesions, 45(33.6%) patients with simple arterio/arteriolosclerosis and 82(32.9%) patients without vascular lesion reached the composite kidney end points ( χ2=6.491, P=0.039). In a multivariable Cox regression model, the presence of microangiopathy lesions was an independent risk factor for kidney disease progression in IgAN patients ( HR=1.872, 95% CI 1.044-3.357, P=0.035), and simple arterio/arteriolosclerosis was not a risk factor for kidney disease progression. Conclusion:It is not uncommon for non-hypertensive patients with IgAN having microangiopathy lesions, which suggests that hypertension is not the sole risk factor for microangiopathy lesions.
