Comparison of clinical and pathological features of secondary IgA nephropathy of ankylosing spondylitis and primary IgA nephropathy.

AIM: Comparison of clinical and pathological features of secondary IgA nephropathy of ankylosing spondylitis (SIgAN-AS) and primary IgA nephropathy (PIgAN). MATERIALS AND METHODS: Clinical characteristics and pathological data of patients diagnosed with IgAN by renal biopsy were collected in our hospital from January 2008 to October 2018. Patients with SIgAN-AS and PIgAN were recruited at a ratio of 1 : 5. Fifteen patients with SIgAN-AS and 75 patients with PIgAN were enrolled in this retrospective study. RESULTS: There were 15 cases in the SIgAN-AS group, including 13 males and 2 females. The cohort of 75 patients with PIgAN included 37 males and 38 females. There were significantly more males in the SIgAN-AS group 13/15 (86.67%) vs 37/75 (49.30%), p < 0.05. Compared with PIgAN patients, SIgAN-AS patients had higher incidences of hematuria (12/15 (80.00%) vs. 37/75 (49.33%), p < 0.05), lower levels of 24-hour urinary protein (0.85 ± 0.68 vs. 1.57 ± 1.54 g, p < 0.05), but higher levels of estimated glomerular filtration rate (eGFR) (CKD-EPI formula; 112.56 ± 24.53 vs. 88.23 ± 29.39, p < 0.05), albumin (44.67 ± 3.48 vs. 41.09 ± 7.07 g/L, p < 0.05), erythrocyte sedimentation rate (ESR) (43.20 ± 33.94 vs. 18.79 ± 16.26 mm/h, p < 0.001), and C-reactive protein (CRP) (21.19 ± 30.61 vs. 2.11 ± 4.58 mg/L, p < 0.001). From the perspective of renal pathology of PIgAN, patients with SIgAN-AS had a lower incidence of renal tubular atrophy/interstitial fibrosis of nephropathy (p < 0.05). Immunohistostaining analysis showed a higher incidence of dominant deposits of single IgA in the mesangial cell area (p < 0.05). CONCLUSION: SIgAN-AS was more commonly observed in males and displayed a milder progression than those PIgAN. The majority of SIgAN-AS patients can be improved by early intervention.

Procalcitonin and N-Terminal Pro-B-Type Natriuretic Peptide for Prognosis in Septic Acute Kidney Injury Patients Receiving Renal Replacement Therapy.

BACKGROUND: Sepsis is a complex clinical syndrome leading to severe sepsis and septic shock. It is very common in the intensive care unit with high mortality. Thus, judging its prognosis is extremely important. Procalcitonin (PCT) and -N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels are commonly elevated in sepsis patients, but only a few are discussed in the septic acute kidney injury patients (AKI) who received renal replacement therapy (RRT). Our study is aimed at investigating the prognostic value of PCT and NT-proBNP in septic AKI patients who received RRT. METHODS: This was a retrospective study of septic AKI patients who underwent RRT in a Chinese university hospital. All enrolled patients tested PCT and NT-proBNP at RRT initiation. PCT and NT-proBNP levels were compared between the survivors and non-survivors. Receiver operating characteristic (ROC) curves of the 2 biomarkers were performed for predicting in-hospital mortality. According to the median value of PCT (16.2 ng/mL) and NT-proBNP (10,271 pg/mL), patients were divided into 4 groups (low PCT and low NT-proBNP; high PCT and low NT-proBNP; low PCT and high NT-proBNP; high PCT and high NT-proBNP). The Kaplan-Meier survival curves were used to analyze the 28-day survival rate in the 4 groups. RESULTS: A total of 81 patients were enrolled in the study. Of which, 48 (59.3%) patients died during hospitalization. The median of NT-proBNP in non-survivors was significantly higher than in survivors (p = 0.001), while PCT had no significant difference (p = 0.412). The area under the ROC curve of PCT and NT-proBNP for predicting in-hospital mortality was 0.561 (95% CI 0.426-0.695) and 0.729 (95% CI 0.604-0.854). Kaplan-Meier survival curve analysis showed that increased NT-proBNP level was associated with 28-day mortality while combined with PCT there was no statistical difference in 4 different level groups. CONCLUSION: NT-proBNP has a certain predictive value for the prognosis in septic AKI patients who received RRT. It seems that the initial PCT value for prognosis is limited. The combination of PCT and -NT-proBNP to evaluate the prognosis in these critically ill patients is currently unclear.