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IgA nephropathy (IgAN) is a common cause of end-stage renal disease (ESRD). IgAN has a variety of manifestations, and its prognosis varies from clinical presentation. Patients with nephrotic syndrome (NS) in IgAN account for about 5-10%, but the clinical characteristics and prognosis of IgAN patients with nephrotic syndrome (NS-IgAN) are still unclear.
A retrospective analysis was conducted, including primary IgAN patients diagnosed through renal biopsy in the Department of Nephrology at General Hospital of Ningxia Medical University from January 2008 to October 2018. According to the clinical manifestations, the patients were divided into nephrotic syndrome (NS) and non-nephrotic syndrome (non-NS) groups. The clinical and pathological features of the two groups were compared, and analysis was performed to identify factors affecting the prognosis of IgAN patients.
A total of 632 IgAN patients were included, of which 88 cases (13.92%) were in the NS group. Compared with the non-NS group, the NS Group patients had higher blood pressure, 24-hour urine protein, lower eGFR, albumin, and more severe degree of tubular atrophy or interstitial fibrosis, these differences were statistically significant (P<0.05).
The median follow-up time was 90.16 (32, 101) months. Among the 632 patients, there were a total of 73 endpoint events, including 4 deaths, 62 cases of ESRD or doubling of creatinine, and 7 cardiovascular events. Kaplan-Meier survival analysis revealed that IgAN patients in the NS group had a poor renal prognosis compared to those in the non-NS group (Log-rank=48.753, P < 0.001). Multivariable COX regression analysis identified segmental sclerosis and tubulointerstitial fibrosis as independent risk factors for the renal prognosis of the NS group, while eGFR and hemoglobin levels were protective factors.
Compared to the non-NS group, the NS group exhibited more severe clinical indicators and pathological changes, resulting in an inferior prognosis.