Nephron. 1999;82(3):205-13. doi: 10.1159/000045404.
Primary chronic glomerulonephritis is the most common cause of end-stage renal failure in Japan. The incidence in dialysis patients in Japan is about four times higher than in the United States for reason which are unclear. We conducted a nationwide survey on the natural history and treatment of primary glomerulonephritis under a program project from the Ministry of Health and Welfare of Japan entitled 'Progressive Chronic Renal Disease'. We analyzed patient characteristics, disease onset, clinical data, and histological findings in 1,850 patients with primary glomerulonephritis from 53 institutions in 1985 who underwent renal biopsy at least 5 years ago, and the follow-up study was carried out 8 years after registration. The incidence of diffuse-mesangial proliferative glomerulonephritis is 41.9%, that of minor glomerular abnormalities 17.5%, and that of focal-mesangial proliferative glomerulonephritis 13.0%. Of 1,045 biopsy specimens that were examined by immunofluorescence microscopy, 47.4% showed IgA nephropathy. Half of all cases with primary chronic glomerulonephritis were asymptomatic and were detected on routine health examination. The survival rates at 20 years from the apparent onset or earliest known renal abnormality are: focal glomerular sclerosis 49%, membranoproliferative glomerulonephritis 58%, diffuse-mesangial proliferative glomerulonephritis 66%, focal-proliferative glomerulonephritis 81%, membranous nephropathy 82%, minor glomerular abnormalities 94%, and IgA nephropathy 61%. In conclusion, a high incidence of IgA nephropathy and a better renal survival of membranous nephropathy are the features of primary chronic glomerulonephritis in Japan. This high incidence of IgA nephropathy together with its poor prognosis is probably the reason for the increased incidence of primary chronic glomerulonephritis in dialysis patients in Japan. In addition, the importance of routine health examination including urinalysis is demonstrated.
原发性慢性肾小球肾炎是日本终末期肾衰竭最常见的病因。日本透析患者中的发病率比美国高出约四倍，原因尚不清楚。我们在日本厚生省名为“进行性慢性肾病”的项目计划下，对原发性肾小球肾炎的自然病史和治疗进行了全国性调查。我们分析了1985年来自53个机构的1850例原发性肾小球肾炎患者的特征、疾病发作情况、临床数据和组织学检查结果，这些患者至少在5年前接受了肾活检，并在登记8年后进行了随访研究。弥漫性系膜增生性肾小球肾炎的发病率为41.9%，轻微肾小球异常为17.5%，局灶性系膜增生性肾小球肾炎为13.0%。在1045份经免疫荧光显微镜检查的活检标本中，47.4%显示为IgA肾病。所有原发性慢性肾小球肾炎病例中有一半无症状，是在常规健康检查中被发现的。从明显发病或最早已知的肾脏异常起算20年的生存率分别为：局灶性肾小球硬化49%，膜增生性肾小球肾炎58%，弥漫性系膜增生性肾小球肾炎66%，局灶增生性肾小球肾炎81%，膜性肾病82%，轻微肾小球异常94%，IgA肾病61%。总之，IgA肾病的高发病率和膜性肾病较好的肾脏生存率是日本原发性慢性肾小球肾炎的特点。IgA肾病的这种高发病率及其不良预后可能是日本透析患者中原发性慢性肾小球肾炎发病率增加的原因。此外，还证明了包括尿液分析在内的常规健康检查的重要性。
