Potential of renal pathology on refining syndrome typing of Chinese medicine in IgA nephropathy.

OBJECTIVE: To investigate the potential of renal pathological index as a differential diagnosis factor for Chinese medicine (CM) syndromes typing in IgA nephropathy (IgAN). METHODS: A total of 1,016 patients with IgAN was recruited from November 2001 to November 2004. All the signs and symptoms including picture of the tongue and pulse tracings were collected. All patients were typed according to the CM syndrome typing scheme for chronic primary glomerulopathy. The severity of glomerulus and tubulointerstitial lesions (mild, moderate-severe) were evaluated using lee's grading system and the Katafuchi score system. RESULTS: The syndrome types transform in turn by deficiency of both the Spleen (Pi) and Lung (Fei) qi, deficiency of both qi and yin, deficiency of Liver (Gan) and Kidney (Shen) yin and deficiency of Spleen-Kidney (Shen) yang, with the aggravation of pathogenetic condition and that the manifestation of deficiency of qi clinically showed proliferative lesion of glomerular mesangium, while the glomerular sclerosis pathologically showed the manifestation of yin deficiency. CONCLUSION: Renal pathological findings may be a candidate of objective factors to refine CM syndrome typing process.

Validation of the Oxford Classification of IgA Nephropathy: A Single-Center Study in Korean Adults

BACKGROUND/AIMS: The recently published Oxford classification of IgA nephropathy (IgAN) proposed a split system for histological grading, based on prognostic pathological features. This new classification system must be validated in a variety of cohorts. We investigated whether these pathological features were applicable to an adult Korean population. METHODS: In total, 69 adult Korean patients with IgAN were analyzed using the Oxford classification system at Soonchunhyang University Hospital, Seoul, Korea. All cases were categorized according to Lee's classification. Renal biopsies from all patients were scored by a pathologist who was blinded to the clinical data for pathological variables. Inclusion criteria were age greater than 18 years and at least 36 months of follow-up. We excluded cases with secondary IgAN, diabetic nephropathy combined other glomerulopathies, less than 36 months of follow-up, and those that progressed rapidly. RESULTS: The median age of the patients was 34 years (range, 27 to 45). Mean arterial blood pressure was 97 +/- 10 mmHg at the time of biopsy. The median follow-up period was 85 months (range, 60 to 114). Kaplan-Meier analysis showed significant prognostic predictions for M, E, and T lesions. A Cox proportional hazard regression analysis also revealed prognostic predictions for E and T lesions. CONCLUSIONS: Using the Oxford classification in IgAN, E, and T lesions predicted renal outcome in Korean adults after taking clinical variables into account.

[Distribution features of Chinese medicine syndrome types in IgA nephropathy patients complicated with hypertension and analysis of its correlated factors].

OBJECTIVE: To explore the distribution features of Chinese medicine syndrome types in immunoglobin A (IgA) nephropathy patients complicated with hypertension and its correlation with main prognostic indicators of hypertension classification and chronic kidney disease (CKD) staging, thus providing the diagnostic standards of Chinese medicine syndrome types and reliance for accurate syndrome differentiated medication. METHODS: By on-the-spot survey, the Chinese medicine syndrome and laboratory testing data of 154 IgA nephropathy patients complicated with hypertension confirmed by the pathology of kidneys were collected to analyze the distribution of Chinese medicine syndrome types, its correlation with hypertension classification and CKD staging. RESULTS: Asthenia was the most common syndrome in the 154 patients (146 cases, 94.81%), covering Pi-Shen deficiency syndrome (58, 37.66%), Shen qi-yin deficiency syndrome (48, 31.17%), and Gan-Shen yin deficiency syndrome (40, 25.97%). Of them, asthenia accompanied by asthenia was seen in 80 cases (54.79%) and pure asthenia in 8 cases (5.2%). Shen qi-yin deficiency syndrome and Gan-Shen yin deficiency syndrome were mostly seen in hypertension III, while Pi-Shen deficiency syndrome was mostly seen in hypertension I. Pi-Shen deficiency syndrome was mostly seen in CKD stage 4, Shen qi-yin deficiency syndrome mostly seen in CKD stage 1-2, and Gan-Shen yin deficiency syndrome mainly distributed in CKD stage 1-3. No obvious correlation was seen between Chinese medicine syndrome types and 24-h urine protein quantitation. CONCLUSIONS: Pi-Shen deficiency syndrome, Shen qi-yin deficiency syndrome, and Gan-Shen yin deficiency syndrome were main Chinese medicine syndrome types in IgA nephropathy patients complicated with hypertension. Asthenia accompanied by asthenia was mostly seen. Pi-Shen deficiency syndrome was mostly seen in hypertension I. Shen qi-yin deficiency syndrome and Gan-Shen yin deficiency syndrome were mostly seen in hypertension III, Shen qi-yin deficiency syndrome mostly seen in CKD stage 1-2, and Gan-Shen yin deficiency syndrome mainly distributed in CKD stage 1-3. Pi-Shen deficiency syndrome was mostly seen in CKD stage 4 patients.

[Correlation between traditional Chinese medicine syndromes in primary immunoglobulin A nephropathy and A267G in 5'-untranslated region within exonal of megsin gene].

OBJECTIVE: To observe the correlation between traditional Chinese medicine (TCM) syndromes ("deficiency of qi and yin" and "deficiency of liver yin and kidney yin") and A267G in 5'-untranslated region within exonal of megsin gene, and to search the substantial genetic basis for micro-differentiation of TCM syndromes in primary immunoglobulin A nephropathy (IgAN). METHODS: A total of 120 IgAN cases meeting the diagnostic criteria were enrolled. The sequence of single nucleotide polymorphism (SNP) of A267G in 5'-untranslated region within exonal of megsin gene was tested. The correlation between SNP and TCM syndromes was observed. RESULTS: There were 83 cases carrying GG genotype, 34 cases carrying GA genotype and 3 cases carrying AA genotype in 120 cases of primary IgAN. There was a high proportion of "deficiency of liver yin and kidney yin" in IgAN cases with AA and GA genotypes, and a high proportion of "deficiency of qi and yin" in IgAN cases with GG genotype (P<0.01). Odds ratio in TCM syndrome distribution between GG genotype and GA plus AA genotype was 9.800, and 95% confidence interval was 3.969-24.199. The discrepancy also resided in IgAN patients with different genders and ages. CONCLUSION: A267G in 5'-untranslated region within exonal of the megsin gene may be one of the substantial genetic basis for differentiating "deficiency of liver yin and kidney yin" syndrome and "deficiency of qi and yin" syndrome in primary IgAN.

[Study on the relationship between blood stasis syndrome and clinical pathology in patients with IgA nephropathy].

OBJECTIVE: To explore the relationship between blood stasis Syndrome and clinical pathological parameters in patients with IgA nephropathy (IgAN). METHODS: The clinicopathological data were analyzed of 94 IgAN patients of traditional Chinese medicine blood stasis syndrome. RESULTS: Of the 94 IgAN patients, 61.70% had blood stasis syndrome (BS) and 38.30% had non- blood stasis syndrome (non-BS). In patients with BS, dark purple tongue proper was the symptom most commonly seen; the clinical manifestations were mostly proteinuria with hematuria, often accompanied with hypertension and renal dysfunction. Compared with those in patients without BS, plasma levels of serum creatinine (SCr), triglyceride (TG) and plasma fibrinogen (FIB) were obviously higher, activated partial thromboplastin time (APTT), and urokinase-type plasminogen activators (u-PA) significantly lower; and scores of glomerular sclerosis, tubular interstitial lesions, interstitial inflammatory cell infiltration, interstitial fibrosis, tubular atrophy and vascular sclerosis significantly higher. Besides, the Lee's grades in them of III - V were mostly seen. CONCLUSION: Blood stasis syndrome of IgAN are correlated with certain clinical parameters and severity of renal pathological changes. The combination of TCM holistic syndrome differentiation and modern medicinal micro-differentiation is more favorable for making clear the nature of blood stasis Syndrome of IgAN.