Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.
Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China.
BMC Nephrol. 2020 Oct 27;21(1):447. doi: 10.1186/s12882-020-02111-1.
Interstitial fibrosis/tubular atrophy (T) score is a known determinant of the progression of immunoglobulin A nephropathy (IgAN). Strong evidence indicates that the components of the coagulation system closely linked with fibrotic events have been highlighted in the kidney. However, whether the coagulation system can affect the renal outcome of IgAN remains unclear. Herein, we investigated the association of coagulation parameters and pathological phenotype of IgAN and their combined effects on the deterioration of renal function.
This retrospective study included N = 291 patients with biopsy-proven IgAN from May 2009 to April 2013 in the Second Xiangya Hospital. Clinical data, pathological features were collected, and the associations of coagulation parameters at biopsy, T score, and renal outcome were evaluated. T score indicated the degree of tubular atrophy or interstitial fibrosis. The renal outcome was defined as an end-stage renal disease (ESRD) or an irreversible 50% estimated glomerular filtration rate (eGFR) reduction.
Shorter prothrombin time (PT) and the activated partial thromboplastin time (APTT) were significantly associated with T (both p < 0.001). PT (< 11.15 s) or APTT (< 29.65 s) had worse cumulative survival rate (p = 0.008, p = 0.027 respectively) and were significantly but not independently associated with a higher risk of renal outcome (p = 0.012, p = 0.032 respectively). In the combined analyses of PT, APTT, and T lesions, the odd ratios for the outcome were significantly higher in the presence of T with PT (< 11.15 s) or APTT (< 29.65 s).
Shorter PT and APTT are associated with an increased incidence of the T lesion and are additional factors that portend a poorer prognosis in IgAN. Monitoring coagulation function might be important when assessing the risk of progression. Additional studies exploring the molecular mechanism between coagulation and IgAN pathology are needed.
间质纤维化/小管萎缩（T）评分是 IgA 肾病（IgAN）进展的已知决定因素。有强有力的证据表明，与纤维化事件密切相关的凝血系统成分已在肾脏中被强调。然而，凝血系统是否会影响 IgAN 的肾脏预后尚不清楚。在此，我们研究了凝血参数与 IgAN 的病理表型之间的关系及其对肾功能恶化的综合影响。
本回顾性研究纳入了 2009 年 5 月至 2013 年 4 月在湘雅二医院行肾活检证实的 291 例 IgAN 患者。收集临床资料和病理特征，评估活检时的凝血参数、T 评分与肾脏预后的关系。T 评分提示小管萎缩或间质纤维化的程度。肾脏预后定义为终末期肾病（ESRD）或不可逆转的肾小球滤过率（eGFR）降低 50%。
凝血酶原时间（PT）和活化部分凝血活酶时间（APTT）较短与 T 显著相关（均 p<0.001）。PT（<11.15s）或 APTT（<29.65s）的累积生存率较差（p=0.008，p=0.027），且与肾脏预后不良的风险显著相关（p=0.012，p=0.032），但无独立相关性。在 PT、APTT 和 T 病变联合分析中，存在 T 合并 PT（<11.15s）或 APTT（<29.65s）时，结局的比值比显著更高。
PT 和 APTT 较短与 T 病变发生率增加相关，是 IgAN 预后不良的附加因素。在评估进展风险时，监测凝血功能可能很重要。需要进一步研究探索凝血与 IgAN 病理之间的分子机制。
