Clinicopathological Characteristics and Prognosis of IgA Nephropathy Combined With Malignant Hypertension Kidney Injury.

Background: IgA nephropathy (IgAN), a major cause of primary glomerulonephritis, is closely associated with malignant hypertension (MHT). This study aimed to explore the clinicopathological characteristics and renal prognosis of patients with IgAN combined with malignant hypertension kidney injury (IgAN-MHT) and investigate the associations of clinicopathological indicators with prognosis.

Methods: In this single-center retrospective cohort study, patients diagnosed with IgAN-MHT through kidney biopsy between January 1, 2008, and June 30, 2023, in our hospital were enrolled. Cox regression models were used to assess the associations between clinical indicators and renal prognosis in IgAN-MHT patients.

Results: A total of 70 patients were included in the analysis of renal function improvement. During a median follow-up time of 9.4 months, 26 patients (37.1%) achieved renal function improvement. Patients in the improved renal function group had higher hemoglobin levels (p = 0.003), lower serum creatinine levels (p = 0.006), a higher proportion of patients using sulodexide (p = 0.018), and a lower proportion of glomerulosclerosis (p < 0.001). Multivariable Cox regression analysis indicated that a higher proportion of glomerulosclerosis was independently associated with a lower likelihood of renal function improvement (HR = 0.97, 95% CI = 0.96-0.99, p = 0.003), while sulodexide administration was independently associated with a higher likelihood of improvement (HR = 2.75, 95% CI = 1.18-6.41, p = 0.019).

Conclusion: This study revealed that in IgAN-MHT patients, a higher proportion of glomerulosclerosis was independently associated with poorer renal outcomes, while the use of sulodexide showed a significant independent association with improved renal function.