Clinicopathologic features and prednisone therapeutic effect of 50 cases of proliferative sclerosing IgA nephropathy / 中华肾脏病杂志

ABSTRACT

Objeetive To analyze the clinicopathologic features of proliferative sclerosing IgA nephropathy and the efficacy of prednisone therapy.Methods A retrospective analysis was conducted,enrolling 50 patients with biopsy-proven primary proliferative sclerosing IgA nephropathy who were admitted in the Hospital from January 2005 to June 2015-26 males and 24 females,mean age (36.8 ± 10.4) years.Clinicopathologic features and prednisone therapeutic effect were analyzed.Results The clinical manifestations of 50 cases were nephritis syndrome with varying degrees of renal insufficiency,including 32 cases (64.0％) with hypertension,15 cases (30.0％) with microscopic hematuria.Renal biopsy showed the incidence of glomerular global sclerosis was 17.0％-47.2％,tubular atrophy/ interstitial fibrosis outstanding (T0 50％,T1 32％,T2 18％).After prednisone treatment,compared with sustained remission group and relapse group,invalid patients had higher incidence of hypertension (P ＜ 0.05),relatively lower Hb (P ＜ 0.01) and serum albumin,more significant renal dysfunction (P ＜ 0.01),more severe glomerular global sclerosis,segmental sclerosis,tubular atrophy/ interstitial fibrosis,while the lower interstitial inflammatory cell infiltration.During the follow-up,which lasted from 6 to 132 months (median 27.3 months),the effective rate of treatment was 74.0％ after sufficient prednisone or half dose prednisone therapy.Repeated recurrence rate was 32.0％.At the end of the follow-up period,13(26.0％) patients entered the stage of uremia.Conclusions Application of glucocorticoids in the treatment of proliferative sclerosing IgA nephropathy can protect renal function and delay the progression of renal impairment.The efficacy of glucocorticoids therapy is significantly associated with the presence or absence of hypertension,the degree of renal function impairment,and the severity of the onset of renal pathology.