Shu K H, Ho W L, Lu Y S, Cheng C H, Wu M J, Lian J D
Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan.
Clin Nephrol. 1999 Jul;52(1):5-9.
To define the long-term outcome of patients with minimal urinary abnormalities (defined by the presence of microscopic hematuria with no or less than 1 gm/day proteinuria), and normal renal function (defined by a serum creatinine < 1.3 mg/dl), we retrospectively studied patients who fulfilled the above criteria and had a kidney biopsy done before the year of 1992 (i.e. at least followed up for 5 years), with a definite pathological diagnosis.
A total of 41 cases among 719 cases of primary glomerulonephritis (5.7%) were enrolled into the study. There were 19 males and 22 females with a mean age of 35.4+/-14.7 years at biopsy. The duration of renal disease was 116.0+/-60.5 months and the duration of follow-up post biopsy was 100.2+/-38.1 months. The pathological diagnosis was: IgA nephropathy (21 cases), focal glomerulosclerosis (9 cases), mesangial proliferative glomerulonephritis (8 cases), membranous glomerulonephritis (2 cases) and acute glomerulonephritis (1 case).
At the end of follow-up, 8 cases (19.5%) had a certain degree of renal insufficiency including 2 (4.9%) in end-stage renal disease. The other cases were either in complete remission (6 cases) or stable condition (27 cases) with persistent microscopic hematuria and normal renal function. The long-term outcome was not correlated with any of the following parameters: age, sex, disease duration, serum creatinine at presentation, daily protein loss at presentation, degree of glomerular change and degree of interstitial inflammatory cell infiltration. However, a poor long-term outcome was correlated with tubular atrophy (p < 0.05) and interstitial fibrosis (p < 0.05).
We conclude that a minimal urinary abnormality with normal renal function at presentation does not necessarily imply a favorable long-term outcome in certain patients. Tubular atrophy and interstitial fibrosis but not glomerular change correlates with a worse prognosis. This further emphasizes the importance of renal biopsy in such cases.
为明确轻度尿液异常（定义为镜下血尿且蛋白尿无或每日少于1克）且肾功能正常（定义为血清肌酐<1.3毫克/分升）患者的长期预后，我们对符合上述标准且于1992年前进行了肾活检（即至少随访5年）且有明确病理诊断的患者进行了回顾性研究。
在719例原发性肾小球肾炎患者中，共有41例（5.7%）纳入本研究。其中男性19例，女性22例，活检时平均年龄为35.4±14.7岁。肾脏疾病病程为116.0±60.5个月，活检后随访时间为100.2±38.1个月。病理诊断为：IgA肾病（21例）、局灶节段性肾小球硬化（9例）、系膜增生性肾小球肾炎（8例）、膜性肾小球肾炎（2例）和急性肾小球肾炎（1例）。
随访结束时，8例（19.5%）出现一定程度的肾功能不全，其中2例（4.9%）为终末期肾病。其他病例要么完全缓解（6例），要么病情稳定（27例），伴有持续性镜下血尿且肾功能正常。长期预后与以下任何参数均无相关性：年龄、性别、疾病病程、就诊时血清肌酐、就诊时每日蛋白丢失量、肾小球病变程度和间质炎性细胞浸润程度。然而，长期预后不良与肾小管萎缩（p<0.05）和间质纤维化（p<0.05）相关。
我们得出结论，就诊时轻度尿液异常且肾功能正常并不一定意味着某些患者有良好的长期预后。肾小管萎缩和间质纤维化而非肾小球病变与预后较差相关。这进一步强调了在此类病例中肾活检的重要性。
