Abstract:

Objective: To observe the histological change of IgA nephropathy (IgAN) based on repeat renal biopsy, and analyze its relationship with treatment and prognosis. Methodology: Pathological changes of ninety one IgAN patients with repeat renal biopsies were analyzed by combining with the clinical features and treatment. The scoring was done according to the Oxford classi?cation. Histological features including: mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis or adhesion (S), tubulointerstitial lesion (T), glomerular crescent formation (C) and capillary necrotizing lesion (N). According to pathological features at first biopsy, the patients were divided into proliferative group (with E, C or N lesion) and non-proliferative group. According to changes of clinical features, the patients were divided into improved group, stable group and progress group. The histological changes were detected at the pathological side and the clinical side respectively. Results:（1） The difference in the usage of immunosuppressant between proliferative group and non-proliferative group was significant (77% VS 23.3%, P<0.01). After immunosuppressive treatment, most proliferative lesions (E, C and N) were reversed. The E, C and N lesions were significantly reduced at second biopsy (E 85%, C 75.6%, N 100%). However, the T lesion kept progressing, and the M and S lesions had no notable change. （2）The difference in the usage of immunosuppressant between improved group and progress group was also significant (72.2% VS 39.3%, P<0.01). At second biopsy, the E and N lesions in improved group were disappeared, and most C lesion was improved significantly, while the C and N lesions in progress group were without change. But the difference of the percentage of the C and N lesions between improved group and progress group at second biopsy was notable (C: 57.1% VS 16.7%, P<0.01, N: 25% VS 0%, P<0.01). The M lesion was ameliorated in improved group, while worsen in progress group. The percentage of M lesion in progress group at the second biopsy was higher than that in improved group (46.4% VS 13.9%, P<0.01). No matter the patients were getting better or worse, the T lesion became more serious, and the S lesion had no change. Conclusion: The proliferative lesions (E, C and N) of IgAN patients can be reversed mostly after immunosuppressive treatment, accompanied with improved pathogenetic condition. The M and T lesions had a close relationship with the prognosis of IgAN, while the S lesion hadn’t.