关键词: IgA肾病   , 微小病变样变  , 临床病理特征  , 激素疗效

Abstract:

Objective: To investigate the clinicopathological features and prednisone therapeutic effect of IgA nephropathy with minimal change lesion. Methodology: Sixty one patients[46 male and 15 female with average age of（23.9±8.65）years old] ，who were biopsy-based IgA nephropathy with the minimal change lesion，were enrolled in this retrospective study. Their clinical manifestations, pathological features and prednisone therapeutic effect were analyzed. Results: Nephrotic syndrome was the primary clinical manifestation. All patients presented severe proteinuria and edema, 15 cases（24.6%）had infections as a motivation, 14 cases（23.0%）showed AKI, 14 cases（23.0%）had microhematuria and 5 cases（8.2%）presented with hypertention. The increasing levels of urine n-acetyglucosaminidase（NAG）（78.7%）and urine retinol binding protein（RBP）（75.4%）were seen in a majority. The histological examinations showed that the glomerular lesion was minimal, and immuneglobulin A alone（14.3%）or togethter with immuneglobulin M (61.9%）were mostly seen in the mesangial region. The renal tubules and interstitial tissues obviously got acute injury with a proportion of 80.3% and 65.6% respectively. During the follow-up of 46 months（24~70）, the effective and relapse rate of prednisone therapy were 91.8% and 76.8%. Compared to responders, the nonresponders got a higher incidence and severity of hematuria（P<0.01）and the hypoproteinemia was not as obvious as the former（P<0.05）.Besides,tubular atrophy，interstitial fibrosis and hyaline degenetantion of arteriole appeared more often in nonresponders（P<0.01）.Till the last follow-up,59 cases（96.7%）still had nomal renal funtion.Conclusion:IgA nephropathy with minimal change like lesion were similar with minimal change desease both in clinical menifestation and pathological feature.Most cases got remission with prednisone therapy,and they usually showed good prognosis .

Key words: IgA nephropathy  , mnimal change like lesion , clinicopathologic features , prednisone therapeutic effect