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Objective:To investigate the correlation among clinical manifestations, pathological changes and immunofluorescence in children with primary IgA nephropathy (IgAN).Methods:The data of a total of 222 cases diagnosed with IgAN by the Department of Nephrology, Jiangxi Children′s Hospital in recent 10 years were collected for the analysis of clinical and pathological features and their correlation.Results:(1)Immunofluorescence showed that 115 cases (51.8%) IgA patients had only mesangial deposition, and 107 cases (48.2%) IgA patients had both mesangial deposition and capillary loop deposition.Most IgA patients (122 cases, 55.0%) had immunofluorescence intensity+ + .In IgA patients, IgM deposition was the most common [168 cases (75.7%)], followed by C 3 deposition [160 cases (72.1%)]. Patients with C 4 deposition were the least[7 cases (3.2%)]. (2) Hypertension were positively correlated with IgM, C 3 deposition, IgA deposition intensity and IgA with vascular loop deposition(all P<0.05). Hyperuricemia was positively correlated with IgM deposition, IgG deposition, C 3 deposition and IgA with vascular loop deposition(all P<0.05); hypoalbuminemia was negatively correlated with IgM deposition, C 3 deposition, IgA deposition intensity and IgA with vascular loop deposition(all P<0.05). Hypercholesterolemia were positively correlated with C 3 deposition and IgA with vascular loop deposition(all P<0.05). Urine protein quantification were positively related to IgM, IgG and IgA with vascular loop deposition (all P<0.05). The estimated glomerular filtration rate(eGFR)was negatively related to IgA with vascular loop deposition( P<0.05). (3) Lee′s grade were positively correlated with IgM and C 3 deposition, IgA deposition intensity and IgA with capillary loop deposition(all P<0.05). (4) Oxford type mesangial hypercellularity(M1)were positively correlated with C 3 deposition and IgA deposition intensity(all P<0.001). Endocapillary hypercellularity(E1)lesions were positively correlated with IgA deposition intensity and IgA with capilla-ry loop deposition(all P<0.05). Segmental glomerulosclerosis(S1)lesions had no correlation with immunofluorescence pathology.Tubular atrophy and interstitial fibrosis(T1)was positively correlated with IgG and C 3 deposition(all P<0.05). (5) There was no correlation between glomerulosclerosis and immunofluorescence pathology.Crescent was positively correlated with IgM deposition, IgG deposition, C 3 deposition, IgA deposition intensity and IgA capillary loop deposition(all P<0.05). Renal artery thickening was positively correlated with IgG deposition and IgA capillary loop deposition(all P<0.05). Conclusions:IgA intensity of + + and IgM deposition are most commonly found in immunofluorescence of children with primary IgAN.IgA patients with capillary loops or C 3 deposition have more severe clinical manifestations and light microscopy results.
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Objective To analyze the incidence of hospitalized children with Henoch-Sch(o)nle in purpura (HSP) and Henoch-Sch(o)nlein purpura nephritis (HSPN) from 2009 to 2012,and to characterize the epidemiology of HSP and HSPN in Jiangxi province.Methods Inpatients of Jiangxi Children's Hospital with the diagnosis of HSP or HSPN were recruited during 2009 to 2012.The basic messages in the home page of medical records,such as the admission year,sex,age,area coming from were collected.Chi-square test was used for statistical analysis.Results A total of 2516 HSP pediatric patients were included in this study.Of whom,412 cases were diagnosed in 2009,568 cases in 2010,750 cases in 2011,786 cases in 2012.Among them,renal damage as the presenting symptom in 110 cases in 2009,148 cases in 2010,198 cases in 2011,and 196 cases in 2012.The average incidence of HSPN was 25.91％ (652/2516).The morbidity of HSPN were similar in different admission years (x2=0.62,P＞0.05).In HSP patients,the ratio between male and female was 1.59∶1; the peak age was 4 to 9 year-old (65.50％,1648/2516).The morbidity of HSPN was similar in both girls and boy patients group (x2=0.14,P＞0.05).The morbidity of HSPN was 18.76％ (163/869) in patients younger than 6 years old,which was lower than 26.85％(359/1337) in patients between age 6 to 11 years old,and the morbidity of HSPN was 41.94％ (130/310) in patients older than 11years old,the difference was significant (x2=65.24,P＜0.01).The morbidity of HSP in the month of year was different,the peak time was between October and December,which as 40.74％(1025/2516).The morbidity of HSPN was 30.23％(208/688) during January to March,higher than in other period of the year (x2=9.87,P＜0.05).In the last four years,there were 824(32.75％) hospitalized patients of HSP in Nanchang district,1692 cases (67.25％) in other areas in Jiangxi province.The morbidity of HSPN in Nanchang district was 17.35％ (143/824),compared with the average level 25.91％(652/2516),the difference was significant (x2=25.08,P＜0.01).Conclusion The number of children diagnosed with HSP is progressively increased from 2009 to 2012 in Jiangxi province.The peak period for HSP is between October and December,and the peak age is 4 to 9 year-old.The incidence of HSPN between January to March group is higher than in other periodof the year.The morbidity of HSPN is increased with age.
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Objective:To analyze the podocalyxin (PCX) expression in the kidney and the number of urinary podocytes in different pathological grades of Henoch-Sch(o)nlein purpura nephritis (HSPN),and to determine whether the number of urinary podocytes reflects the renal damage in HSPN.Methods:Fifty-six children diagnosed with HSPN in our hospital were enrolled in the study and classified into 4 groups by renal pathology:grade Ⅱ (Ⅱa+Ⅱb) (n=10),grade Ⅲ (Ⅲa+Ⅲb) (n=21),grade Ⅳ (n=16),and grade Ⅴ (n=9).Four kidney autopsy specimens without histomorphologic lesions and 8 urine samples from healthy children served as controls.With immunofluorescence assay,the PCX expression in 4 normal renal tissues and in the renal tissues of the 56 HSPN children was detected and quantitatively analyzed.Positive rate and the number of urinary podocytes were detected in the 8 healthy children and 56 HSPN children.Results:In the renal tissues of the normal control group and grade Ⅱ (Ⅱa+Ⅱb) HSPN group,the PCX expression was complete.The percentage of the PCX positive area out of the total glomerular area in the renal tissues of 2 groups had no significant difference (P＞0.05).In the renal tissues of grade Ⅲ (Ⅲa+Ⅲb),Ⅳ,and Ⅴ HSPN groups,the PCX expression showed various degrees of loss,decreasing in turn from grade Ⅱ (Ⅱa+Ⅱb),Ⅲ (Ⅲa+Ⅲb),Ⅳ to Ⅴ,with significant differences between each group (P＜0.01).For HSPN with grade Ⅲ (Ⅲa+Ⅲb) or higher,positive PCX expression was found in the urine,suggesting the presence of enough podocytes in the urine.The percentage of fluorescence positive area out of the total glomerular area of PCX in the renal tissues was negatively correlated with the total number of urinary podocytes (r=-0.637,P＜0.01).Conclusion:Podocyte injury plays a certain role in the pathological progression of HSPN.The urinary detection ofpodocytes can reflect the degrees of pathological damage in HSPN.
