Correlation analysis of intrarenal arteriolar hyalinosis in IgA nephropathy with mild proteinuria and without hypertension

doi:10.3877/cma.j.issn.2095-3216.2017.03.007

Abstract

Abstract:

Objective

To explore the correlation of intrarenal arteriolar hyalinosis (AH) with clinical and pathological indicators in IgA nephropathy (IgAN) with mild proteinuria and without hypertension.

Methods

Retrospective analysis was performed in patients with newly biopsy-confirmed IgAN between January 1, 2010 and December 31, 2014 in the Department of Nephrology, Chinese PLA General Hospital. The patients′ clinical data during the week before renal biopsy were collected. Pathological lesions were evaluated according to the updated Oxford Classification. Patients were divided into intrarenal AH group and non-AH group. Clinical and pathological indictors were compared between the two groups. The correlation of intrarenal AH with clinical and pathological indicators was analyzed using multivariant logistic regression method.

Results

A total of 126 IgAN cases without hypertension were enrolled, among whom 44 (34.92%) cases had intrarenal AH. All the 126 cases had proteinuria ≤1 g/d. The age, body mass index, serum uric acid, urea nitrogen, and creatinine were higher in intrarenal AH group than in non-AH group (P<0.05). And eGFR of intrarenal AH group was lower than that of non-AH group (P<0.05). There were significant differences in chronic kidney disease stages and tubular atrophy/interstitial fibrosis between the two groups (z=3.290, P=0.001; z=3.293, P=0.001). Multivariant logistic regression analysis showed that intrarenal AH of IgAN was correlated with male (OR 3.08, 95%CI 1.03-9.18), each age increase by 10 years (OR 3.02, 95%CI 1.79-5.07), each body mass index increase by 10 kg/m² (OR 7.08, 95%CI 1.54-32.42), and tubular atrophy/interstitial fibrosis (OR 5.96, 95%CI 2.11-16.80).

Conclusion

It is not uncommon for IgAN patients with mild proteinuria and without hypertension to have intrarenal AH. Gender, age, body mass index, and tubular atrophy/interstitial fibrosis were correlated with intrarenal AH of IgAN.

Key words: IgA nephropathy, Intrarenal arteriolar hyalinosis, Pathology

Shuwei Duan, Ding Chen, Jie Wu, Shuwen Liu, Ying Zheng, Yuansheng Xie, Guangyan Cai. Correlation analysis of intrarenal arteriolar hyalinosis in IgA nephropathy with mild proteinuria and without hypertension[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2017, 06(03): 127-131.

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Figures/Tables 6

References 22

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指标		无肾内AH组(n＝82)	有肾内AH组(n＝44)	t值或χ²值	P值
年龄(岁)		33.73±9.76	41.95±9.15	4.605	<0.001
性别(男)		44(53.66)	31(70.45)	3.353	0.067
BMI(kg/m²)		23.82±3.60	25.96±3.03	3.346	0.001
收缩压(mmHg)		123.67±14.79	129.02±17.78	1.802	0.074
舒张压(mmHg)		79.11±10.61	82.25±13.32	1.446	0.151
平均动脉压(mmHg)		93.96±11.31	97.84±13.90	1.691	0.093
血尿酸(mmol/L)		358.29±105.34	406.51±96.89	2.518	0.013
血清白蛋白(g/L)		42.57±3.78	41.63±3.35	1.371	0.173
尿蛋白定量(g/d)		0.60±0.24	0.66±0.22	1.301	0.196
尿素氮(mmol/L)		5.05±1.93	6.42±2.38	3.489	0.001
肌酐(μmol/L)		85.70±34.96	105.03±37.48	2.884	0.005
eGFR[mL/(min ·1.73 m²)]		96.48±24.85	77.14±24.55	4.182	<0.001
甘油三酯(mmol/L)		1.54±0.89	1.85±0.83	1.887	0.062
总胆固醇(mmol/L)		4.20±0.80	4.48±0.73	1.915	0.058
CKD分期^a		?	?	3.290	0.001
?	1期	55(67.07)	16(36.36)	?	?
?	2期	16(19.51)	16(36.36)	?	?
?	3a期	9(10.98)	7(15.91)	?	?
?	3b期	1(1.22)	4(9.09)	?	?
?	4期	1(1.22)	1(2.27)	?	?

指标		无肾内AH组(n＝82)	有肾内AH组(n＝44)	t值或χ²值	P值
年龄(岁)		33.73±9.76	41.95±9.15	4.605	<0.001
性别(男)		44(53.66)	31(70.45)	3.353	0.067
BMI(kg/m²)		23.82±3.60	25.96±3.03	3.346	0.001
收缩压(mmHg)		123.67±14.79	129.02±17.78	1.802	0.074
舒张压(mmHg)		79.11±10.61	82.25±13.32	1.446	0.151
平均动脉压(mmHg)		93.96±11.31	97.84±13.90	1.691	0.093
血尿酸(mmol/L)		358.29±105.34	406.51±96.89	2.518	0.013
血清白蛋白(g/L)		42.57±3.78	41.63±3.35	1.371	0.173
尿蛋白定量(g/d)		0.60±0.24	0.66±0.22	1.301	0.196
尿素氮(mmol/L)		5.05±1.93	6.42±2.38	3.489	0.001
肌酐(μmol/L)		85.70±34.96	105.03±37.48	2.884	0.005
eGFR[mL/(min ·1.73 m²)]		96.48±24.85	77.14±24.55	4.182	<0.001
甘油三酯(mmol/L)		1.54±0.89	1.85±0.83	1.887	0.062
总胆固醇(mmol/L)		4.20±0.80	4.48±0.73	1.915	0.058
CKD分期^a		?	?	3.290	0.001
?	1期	55(67.07)	16(36.36)	?	?
?	2期	16(19.51)	16(36.36)	?	?
?	3a期	9(10.98)	7(15.91)	?	?
?	3b期	1(1.22)	4(9.09)	?	?
?	4期	1(1.22)	1(2.27)	?	?

组别	例数	M1^a	E1^a	S1	T^b		C1	补体C3
组别	例数	M1^a	E1^a	S1	T1	T2	C1	补体C3
无肾内AH组	82	10(12.20)	4(4.88)	50(60.98)	15(18.29)	2(2.44)	20(24.39)	14(58.33)
有肾内AH组	44	3(6.82)	2(4.55)	26(59.09)	15(34.09)	6(13.64)	5(11.36)	10(41.67)
χ²值或z值	－	－	－	0.042	3.293	3.055	0.594	?
P值	－	0.267	0.651	0.837	0.001	0.080	0.441	?

组别	例数	M1^a	E1^a	S1	T^b		C1	补体C3
组别	例数	M1^a	E1^a	S1	T1	T2	C1	补体C3
无肾内AH组	82	10(12.20)	4(4.88)	50(60.98)	15(18.29)	2(2.44)	20(24.39)	14(58.33)
有肾内AH组	44	3(6.82)	2(4.55)	26(59.09)	15(34.09)	6(13.64)	5(11.36)	10(41.67)
χ²值或z值	－	－	－	0.042	3.293	3.055	0.594	?
P值	－	0.267	0.651	0.837	0.001	0.080	0.441	?

指标	参数估计值	OR(95%CI)	Wald	P值
年龄(每增加10岁)	0.85	2.34(1.55～3.54)	16.304	<0.001
男/女(1/0)	0.72	2.06(0.94～4.49)	3.299	0.069
BMI(每增加10 kg/m²)	1.83	6.24(1.97～19.80)	9.657	0.002
平均动脉压(每增加10 mmHg)	0.26	1.29(0.96～1.75)	2.766	0.096
尿素氮(mmol/L)	0.32	1.38(1.12～1.70)	8.935	0.003
血肌酐(每增加10 μmol/L)	0.15	1.16(1.04～1.31)	6.578	0.010
eGFR[每增加10 mL/ (min· 1.73 m²)]	－0.30	0.74(0.64～0.87)	14.007	<0.001
血尿酸(每增加100 mmol/L)	0.45	1.57(1.08～2.27)	5.725	0.017
甘油三酯(mmol/L)	0.39	1.48(0.97～2.25)	3.263	0.071
总胆固醇(mmol/L)	0.46	1.59(0.98～2.57)	3.520	0.061
新月体病变	－0.92	0.40(0.14～1.15)	2.918	0.088
肾小管萎缩/间质纤维化病变^a	1.25	3.49(1.57～7.75)	9.455	0.002

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