Analysis of renal pathological characteristics of IgA vasculitis nephritis with nephrotic syndrome in children

doi:10.11958/20253189

Abstract

Abstract:

Objective To investigate the differences in renal pathological features between nephrotic syndrome (NS) type and non-NS type in children with IgA vasculitis nephritis (IgAVN). Methods The renal pathological data of 349 children with IgAVN presenting with nephrotic-range proteinuria were retrospectively analyzed. According to the presence or absence of NS, patients were divided into the NS group (n=56) and the non-NS group (n=293). The clinical characteristics and pathological types were compared between the two groups. Results Among the 349 children with IgAVN, the majority showed ISKDC grade Ⅲ or higher lesions (78.2%, 273/349). Immunofluorescence was dominated by IgA deposition (74.8%, 261/349), and 41.0% (143/349) of the patients had concomitant C3 deposition. The 24-hour urinary protein quantification was positively correlated with pathological grading, mesangial proliferation degree and crescent proportion (all P<0.05). Compared with the non-NS group, the NS group had significantly higher proportions of gross hematuria, ISKDC gradeⅡb and Ⅳ lesions, severe mesangial proliferation, crescent proportion (≥25%) and tubulointerstitial injury (all P<0.05). Conclusion NS-type IgAVN is more severe in terms of crescent formation, severe mesangial proliferation and renal tubulointerstitial injury.

Key words: vasculitis, nephritis, immunoglobulin A, nephrotic syndrome, pathological characteristics

CLC Number:

R692.3

Figures/Tables 5

References 26

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病理特征	n	24 h尿蛋白定量/mg	F、H或Z	r_s
病理分级
Ⅱa级	50	2 261.2（1 712.3，3 084.1）	61.881^＊＊	0.264^＊＊
Ⅱb级	26	4 150.1（2 445.1，6 977.6）^a
Ⅲa级	140	2 267.5（1 700.7，3 476.9）^b
Ⅲb级	117	3 610.2（2 845.7，4 632.2）^ac
Ⅳ级	16	3 224.8（2 708.4，4 617.6）^ac
C3沉积
无	206	2 786.5（2 048.8，3 958.2）	0.190	0.095
有	143	2 939.6（1 949.8，4 084.0）	0.190	0.095
免疫复合物类型
IgA型	261	3 228.7±1 743.8	2.923	0.043
IgA+IgG型	8	2 889.9±1 087.2
IgA+IgM型	77	3 445.1±1 943.2
IgA+IgG+IgM型	3	2 302.3±1 682.4
系膜增生程度
轻度	78	2 279.7（1 735.5，3 090.0）	21.262^＊＊	0.237^＊＊
中度	63	2 637.0（2 110.0，3 928.3）
重度	208	3 279.5（2 148.7，4 372.2）^de
新月体比例
<25%	296	2 622.2（1 865.1，3 940.7）	15.048^＊＊	0.227^＊＊
25%~49%	40	3 397.5（2 941.7，4 836.9）^f
≥50%	13	3 495.1（2 646.1，4 667.9）

病理特征	n	24 h尿蛋白定量/mg	F、H或Z	r_s
病理分级
Ⅱa级	50	2 261.2（1 712.3，3 084.1）	61.881^＊＊	0.264^＊＊
Ⅱb级	26	4 150.1（2 445.1，6 977.6）^a
Ⅲa级	140	2 267.5（1 700.7，3 476.9）^b
Ⅲb级	117	3 610.2（2 845.7，4 632.2）^ac
Ⅳ级	16	3 224.8（2 708.4，4 617.6）^ac
C3沉积
无	206	2 786.5（2 048.8，3 958.2）	0.190	0.095
有	143	2 939.6（1 949.8，4 084.0）	0.190	0.095
免疫复合物类型
IgA型	261	3 228.7±1 743.8	2.923	0.043
IgA+IgG型	8	2 889.9±1 087.2
IgA+IgM型	77	3 445.1±1 943.2
IgA+IgG+IgM型	3	2 302.3±1 682.4
系膜增生程度
轻度	78	2 279.7（1 735.5，3 090.0）	21.262^＊＊	0.237^＊＊
中度	63	2 637.0（2 110.0，3 928.3）
重度	208	3 279.5（2 148.7，4 372.2）^de
新月体比例
<25%	296	2 622.2（1 865.1，3 940.7）	15.048^＊＊	0.227^＊＊
25%~49%	40	3 397.5（2 941.7，4 836.9）^f
≥50%	13	3 495.1（2 646.1，4 667.9）

组别	n	年龄/岁	男性	肉眼血尿
非NS组	293	9.31±2.66	169（57.7）	24（8.2）
NS组	56	9.09±2.76	26（46.4）	16（28.6）
t或χ²		0.452	2.414	19.243^＊＊

组别	n	年龄/岁	男性	肉眼血尿
非NS组	293	9.31±2.66	169（57.7）	24（8.2）
NS组	56	9.09±2.76	26（46.4）	16（28.6）
t或χ²		0.452	2.414	19.243^＊＊

组别	n	Ⅱa	Ⅱb	Ⅲa	Ⅲb	Ⅳ
非NS组	293	46（15.7）	14（4.8）	131（44.7）	92（31.4）	10（3.4）
NS组	56	4（7.1）	12（21.4）	9（16.1）	25（44.6）	6（10.7）
Z		1.997^＊