Study on the Relationship between Urinary Series Proteins and Prognosis and Oxford Classification in Patients with Primary IgA Nephropathy
Objective:To analyze the data of urinary serial proteins in patients with primary immunoglobulin nephropathy(IgAN),and to explore the relationship between urinary serial proteins and the prognosis of this population and its relationship with Oxford classi-fication.Methods:The clinical data of 146 primary IgAN patients admitted to the Second Affiliated Hospital of Anhui Medical University from January 2012 to July 2021 were retrospectively analyzed.All patients were followed up,and the renal prognosis was evaluated by endpoint events.The cut-off value of urinary series proteins was obtained by receiver operating characteristic(ROC)curve,and the uri-nary series proteins were divided into high-level group and low-level group according to the cut-off value,the prognosis of IgAN patients with different levels of urinary series proteins were analyzed by Kaplan-Meier survival curve.The influencing factors of renal prognosis in IgAN patients were analyzed by COX proportional hazard model.The differences of urinary series proteins in patients with different Oxford classification were compared.Results:The median follow-up time was 78.00(58.00,95.00)months,and a total of 42 patients had endpoint events.Kaplan-Meier survival curve showed that urinary N-acetyl-β-D-glucosidase(NAG),urinary α1-microglobulin(α1-MG),urinary β2-microglobulin(β2-MG),urinary microalbumin(Alb),urinary immunoglobulin(IgG)and urinary transferrin(TRF)low level group had significantly higher cumulative survival rate than urinary NAG,urinary αl-MG,urinary β2-MG,urinary Alb,urinary IgG and urinary TRF high level group(P＜0.05).Univariate COX survival analysis showed that,the levels of urinary NAG,urinary β2-MG and uri-nary IgG in good prognosis group were significantly lower than those in poor prognosis group(P＜0.05).Multivariate COX survival anal-ysis showed that elevated urinary NAG,urinary IgG and urinary β2-MG were independent risk factors for poor renal prognosis in primary IgAN patients.The urinary NAG level of endothelial cell proliferative lesions was significantly higher than that in other two groups,the urinary IgG of segmental sclerosis lesions was significantly higher than that in other two groups,and the urinary β2-MG of renal tubular atrophy/interstitial fibrosis was significantly higher than that in other two groups(P＜0.05).Conclusion:The increase of urinary NAG,urinary IgG and urinary β2-MG are independent risk factors for poor renal prognosis in primary IgAN patients,and are associate with endothelial cell proliferation,segmental sclerosis,tubular atrophy or renal interstitial fibrosis in Oxford classification.
IgA nephropathyUrinary immunoglobulinUrinary N-acetyl-β-D-glucosidaseUrinary β2 microglobulinOxford clas-sificationPrognosis
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