Significance of Arterial Lesions in IgA Nephropathy Patients with Normal Blood Pressure

Objective:Arteriosclerosis is traditionally thought to be related with hypertension.However,intrarenal arteriosclerosis was observed in some IgA nephropathy(IgAN) patients with normal blood pressure.This study was designed to compare the clinical and pathological characteristics of those normotensive IgAN patients with or without arterial lesions,and to investigate the factors that affecting intrarenal arterial lesions in IgAN patients with normal blood pressure.Methods:All normotensive patients(BP140/90 mmHg before renal biopsy) were diagnosed as primary IgAN by renal biopsy.The intrarenal arterial lesions were defined as thickening and/or hyalinosis of the small arteries via light microscope.105 patients were enrolled and divided into two groups:52 patients with intrarenal arterial lesions in group 1,and 53 patients without intrarenal arterial lesions in group 2.The semiquantitative scoring criteria of the pathological changes in intrarenal arteries was:0:no change;1:25%;2:≥25%,50%;3:≥50%。Statistics:After comparing the clinical and pathological characteristics in two groups,those single factors with statistic significance were rendered into multifactor analysis,and the affecting factors were analyzed by stepwise regression analysis.Results:When compared with group 2,there was a significantly increased age,serum creatinine,serum uric acid,daily urine protein excretion,urine NAG,and more severe glomerulosclerosis,tubular atrophy and interstitial fibrosis,and a markedly decreased urine osmotic pressure at the time of renal biopsy in group 1.Multifactor analysis showed that serum creatinine,urine osmotic pressure,tubular atrophy and interstitial fibrosis are independently affecting factors for intrarenal arterial lesions in IgAN patients with normal blood pressure.The severity of intrarenal arterial lesions is positively correlated with serum creatinine,tubular atrophy and interstitial fibrosis,and negatively correlated with urine osmotic pressure.Conclusion:The results of this study showed that intrarenal arterial lesions in IgAN patients with normal blood pressure is mainly associated with age,elevated serum creatinine and uric acid,and is usually accompanied with tubulointerstitial lesions.