OBJECTIVES: To study the significance of serum 25-hydroxyvitamin D₃ [25-(OH)D₃] level in the clinicopathological characteristics and prognosis of children with immunoglobulin A vasculitis nephritis (IgAVN). METHODS: A retrospective analysis was conducted on the clinical data of children with IgAVN who underwent renal biopsy at Suzhou Hospital Affiliated to Anhui Medical University and Jinling Hospital of the Medical School of Nanjing University from June 2015 to June 2020. Based on serum 25-(OH)D₃ level, the patients were divided into a normal group and a lower group. The clinicopathological characteristics and follow-up data of the two groups were collected and compared. RESULTS: A total of 359 children with IgAVN were included. Compared to the normal group (62 cases), the lower group (297 cases) exhibited higher incidences of hematochezia and gross hematuria, higher levels of serum creatinine, blood urea nitrogen, urinary retinol protein, urinary N-acetyl-β-D-glucosaminidase, and quantitative urinary protein, and a longer duration from renal biopsy to urinary protein becoming negative, as well as lower estimated glomerular filtration rate and albumin level (P<0.05). Renal pathology in the lower group showed a higher occurrence of tubular interstitial injury, crescent formation, segmental sclerosis in glomeruli, and inflammatory cell infiltration in the renal interstitium compared to the normal group (P<0.05). Survival analysis indicated that the cumulative renal survival rate was lower in the lower group (P<0.05). Multivariate Cox regression analysis revealed that low serum 25-(OH)D₃ level is an independent risk factor for poor prognosis in children with IgAVN. CONCLUSIONS Children with IgAVN and low serum 25-(OH)D₃ level have relatively severe clinicopathological manifestations. Low serum 25-(OH)D₃ level is an independent risk factor for poor prognosis in children with IgAVN.
Humans ; Male ; Female ; Child ; Prognosis ; Retrospective Studies ; Calcifediol/blood* ; Child, Preschool ; Adolescent ; Glomerulonephritis, IGA/mortality* ; Vasculitis/pathology* ; IgA Vasculitis/mortality*

The induction of heme oxygenase-1 (HO-1) ameliorates oxidative stress and inflammatory process, which play important roles in IgA nephropathy. We hypothesized length polymorphism in the promoter region of the HO-1 gene, which is related to the level of gene transcription, is associated with disease severity of IgA nephropathy. The subjects comprised 916 patients with IgA nephropathy and gene data. Renal impairment was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) at diagnosis. The short (S: <23), medium (M: 23-28), and long (L: >28) (GT) repeats in the HO-1 gene was determined. The frequencies of S/S, S/M, M/M, S/L, L/M, and L/L genotypes were 7.2%, 6.9%, 3.1%, 30.8%, 22.7%, and 29.4%, respectively. The baseline characteristics were not different. In the S/S genotypic group, the renal impairment rate was 18.2%, which was lower than 32.2% in the group with M/M, L/M, or L/L genotype. The odds ratio of renal impairment in S/S genotype, compared to that in M/M, L/M, or L/L genotype, was 0.216 (95% confidence interval, 0.060-0.774, p=0.019). The HO-1 gene promoter length polymorphism was related to the renal impairment of IgA nephropathy at diagnosis, which is an important risk factor for mortality in IgA nephropathy patients.
Adult ; Disease Progression ; Female ; Gene Frequency ; Genotype ; Glomerular Filtration Rate ; Glomerulonephritis, IGA/*genetics/mortality/*pathology ; Heme Oxygenase-1/*genetics ; Humans ; Male ; Middle Aged ; Odds Ratio ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Risk Factors

OBJECTIVETo understand the clinical features and prognosis of IgA nephropathy (IgAN) patients with glomerular crescents.

METHODSThe clinical data collected at the time of renal biopsy and the follow-up data of 89 IgAN patients with glomerular crescents were analyzed with 412 IgAN patients without crescents serving as the control group. Follow-up study was conducted in 78 patients with crescents and 198 without it, and the renal survival rate was estimated using Kaplan-Meier survival analysis.

RESULTSThe incidence of glomerular crescents was 17.8% in IgAN patients. Clinically, 39 patients with crescents experienced rapidly progressive glomerulonephritis, resulting in a significantly higher rate of this manifestation than that in patients without crescent. Patients with crescents also had more grave pathological changes in the glomerulus and renal tubule interstitium than the control patients. Patients were followed up for an average of 40.3-/+29.6 months in crescent group and 45.1-/+26.9 months in the control group, and the 1-, 3-, 5-year renal survival rate was 95.24%, 80.95%, 61.9% in the former and 100%, 91.67%, 79.17% in the latter, respectively.

CONCLUSIONIgAN patients with crescents have severer clinical and pathological manifestations and poorer prognosis than those without crescents.

Adolescent ; Adult ; Aged ; Child ; China ; epidemiology ; Female ; Follow-Up Studies ; Glomerulonephritis, IGA ; mortality ; pathology ; Humans ; Kaplan-Meier Estimate ; Kidney Glomerulus ; pathology ; Male ; Middle Aged ; Prognosis ; Survival Rate

BACKGROUND: Mild renal dysfunction is relatively common in patients with long standing primary hypertension, ranging from 10% to 40% in various studies. The presence of renal dysfunction is associated with high cardiovascular mortality and morbidity rates of patients with primary hypertension. The purpose of this study is to analyze the clinical characteristics of patients with severe hypertension and reVersible renal dysfunction after blood pressure control. METHODS: This retrospective study enrolled 14 patients with severe hypertension and reVersible renal dysfunction after blood pressure control, between January 1993 and December 2002 at Kangnam St. Mary's Hospital and St. Paul's Hospital. We investigated the laboratory data using Wilcoxon signed rank test, and analysed renal biopsy findings and antihypertensive drugs. RESULTS: The mean age of the patients was 38+/-9 years and the number of male patients was 8. During 33.5+/-28.8 months of mean follow-up period, there was a significant decrease in mean arterial pressure and serum creatinine level, and significant increase in hematocrit level. But there was no significant changes in the level of uric acid, total cholesterol, and triglyceride. Each patient took more than 3 antihypertensive drugs consisting angiotensin converting enzyme inhibitor or angiotensin II receptor blocker (22%), calcium channel blocker (21%), and beta blocker (21%). Renal biopsy was done in 6 cases, and histologic diagnosis resulted in 4 cases of benign hypertensive nephrosclerosis and 2 cases of IgA nephropathy. The typical morphological features of hypertensive nephrosclerosis were seen in all cases, and there were varying degrees of glomerular sclerosis from 0% to 92%. But the percent of glomerular sclerosis was not related to the level of initial serum creatinine, mean arterial pressure, and amount of proteinuria per day. CONCLUSION: Careful monitoring of renal function and effective treatment of blood pressure are therefore mandatory in treating young patient with severe hypertension with renal dysfunction.
Antihypertensive Agents ; Arterial Pressure ; Biopsy ; Blood Pressure* ; Calcium Channels ; Cholesterol ; Creatinine ; Diagnosis ; Follow-Up Studies ; Glomerulonephritis, IGA ; Hematocrit ; Humans ; Hypertension ; Male ; Mortality ; Nephrosclerosis ; Peptidyl-Dipeptidase A ; Proteinuria ; Receptors, Angiotensin ; Renal Insufficiency ; Retrospective Studies ; Sclerosis ; Triglycerides ; Uric Acid