Clinical and Pathological Features of Idiopathic IgA Nephropathy with Gross Hematuria

【Objective】Idiopathic IgA nephropathy(IgAN) with gross hematuria may be a different type of IgAN,its clinical and pathological features need to be identified.【Methods】Ninety four patients diagnosed as idiopathic IgAN based on renal biopsy in our hospital were enrolled in this study.According to the presence of gross hematuria,these patients were divided into two groups,their clinical and pathological data were compared each other.The renal pathological changes of all patients were assessed according to Lee's classification criteria,Katafuchi's semi-quantity score was used to evaluate severity of the glomerular,interstitial,renal tubular and vascular lesions.【Results】Among 94 patients diagnosed as idiopathic IgAN,21.3%(20/94) presented with gross hematuria.In both groups,adolescent male patients were more dominant(male/female=2.13/1).Preceding infections,usually upper respiratory tract infections,were common in these patients.When compared with the patients without gross hematuria,the patients with gross hematuria were younger(P0.05) and with much lower serum creatinine levels at onset(P0.01),but the clinical course and the amount of urinary protein excretion were not significantly different.The majority of renal pathological lesions were Ⅲ~Ⅳ grade,when assessed by Lee's classification criteria,with comparable distribution in both groups.Katafuchi's semi-quantity scores of the whole renal pathology,vascular lesions and glomerulosclerosis in gross-hematuria group were significantly lower than in non-gross-hematuria group(P0.05).【Conclusion】IgAN with episodes of gross hematuria is found more prevalently in adolescent males,most preceded by infections,usually upper respiratory tract infections.A relatively better manifestations of clinical presentations,renal pathological lesions are found in IgAN with gross hematuria,and may imply a relatively good prognosis.