The Clinical and Pathological Characteristics of IgA Nephropathy in High-Altitude Regions and an Analysis of Factors Influencing Treatment Efficacy

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The Clinical and Pathological Characteristics of IgA Nephropathy in High-Altitude Regions and an Analysis of Factors Influencing Treatment Efficacy

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Co-author 1

Zhan Li lizhan98142@hotmail.com Beijing Hospital Nephrology Beijing China *

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Yonghui Mao mmdn2009@163.com Beijing Hospital Nephrology Beijing China -

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Introduction

To investigate the clinical and pathological characteristics of IgA nephropathy patients in high-altitude regions and to identify the clinical and pathological factors influencing therapeutic efficacy.

Methods

A total of 161 patients with primary IgA nephropathy confirmed by renal biopsy and enrolled in regular cohort follow-up at the Affiliated Hospital of Qinghai University from January 2022 to December 2024 were included. Clinical data, laboratory findings, renal histopathology, treatment regimens, and follow-up information were collected. Multivariate logistic regression was used to identify clinical and pathological factors influencing therapeutic efficacy.

Results

1.Clinical profile of high-altitude IgAN patients:
Mean age 38.7 ± 13.67 years. Ethnic distribution: Han 98 (60.9 %), Tibetan 34 (21.1 %), Mongolian 6 (3.7 %), Hui 17 (10.6 %), others 6 (3.7 %). At biopsy: serum creatinine 103.58 ± 74.78 µmol/L; 24-h urinary protein 2.87 ± 3.13 g.

2.Renal histopathology:
Oxford MEST-C scores in 120 biopsies:M1 30/120 (25 %), M0 90/120 (75 %)；E1 72/120 (60 %), E0 48/120 (40 %)；S1 77/120 (64.2 %), S0 43/120 (35.8 %)；T2 11/120 (9.2 %), T1 31/120 (25.8 %), T0 78/120 (65 %)；Crescents: (8.63 ± 12) %, median 3.9 % (range 0–14.3 %).

3.Clinicopathological correlations: E1 vs E0: 24-h proteinuria significantly higher (U = 2100.5, P = 0.046); serum C3 lower in E1 (1.03 ± 0.21 vs 1.14 ± 0.30, P = 0.022).

M1 vs M0: higher creatinine (130.23 ± 112.06 vs 93.38 ± 57.50 µmol/L, P = 0.021) and lower C3 (0.95 ± 0.29 vs 1.12 ± 0.23, P = 0.002). T-score: both T2 and T1 groups had higher 24-h proteinuria (H = 16.39, P < 0.001), creatinine and BUN than T0 (ANOVA, P < 0.001).

4.Treatment regimens:
14 patients (8.7 %) received no therapy; 80 (49.7 %) RAS-blocker monotherapy; 18 (11.2 %) steroid monotherapy; 49 (30.4 %) steroid + RAS blocker. Overall, 129 (80.1 %) used RAS inhibitors and 67 (41.6 %) received steroids.

5.Multivariate logistic regression:
Baseline serum creatinine, T-score, crescent percentage, and steroid therapy were independent determinants of 3-month treatment response.

Conclusion

In high-altitude IgA nephropathy, the frequencies of E and S lesions are high; both E and T lesions correlate closely with clinical severity and can serve as key indicators of disease activity. Baseline serum creatinine, T-score, crescent percentage, and glucocorticoid therapy are independent risk factors influencing therapeutic efficacy in this population.

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