Braden G L, Mulhern J G, O'Shea M H, Nash S V, Ucci A A, Germain M J
Departments of Medicine and Pathology, Baystate Medical Center, Springfield, MA 01199, USA.
Am J Kidney Dis. 2000 May;35(5):878-83. doi: 10.1016/s0272-6386(00)70258-7.
Studies performed at large metropolitan medical centers have reported an increasing incidence of idiopathic focal segmental glomerulosclerosis (FSGS) in adults. To determine whether a similar trend occurs in small urban and rural communities and to determine the role of race in these observations, we reviewed the patient records of all adults who underwent renal biopsies at our institution over the 20-year period from 1974 to 1994. The patients were grouped for analysis in 5-year intervals, 1975 to 1979, 1980 to 1984, 1985 to 1989, and 1990 to 1994, for the following diagnoses: FSGS, membranous nephropathy (MN), minimal change nephropathy (MCN), membranoproliferative glomerulonephritis (MPGN), immunoglobulin A (IgA) nephropathy, chronic glomerulonephritis, diabetic nephropathy, hypertensive nephrosclerosis, and chronic interstitial nephritis. Patients with secondary causes for these lesions were excluded. The relative frequency of FSGS increased from 13.7% during 1975 to 1979 to 25% during 1990 to 1994 (P < 0.05). The relative frequency of MN decreased from 38.3% during 1975 to 1979 to 14.5% during 1990 to 1994 (P < 0.01). There were no changes in the frequencies of MCN, MPGN, IgA nephropathy, chronic glomerulonephritis, diabetic nephropathy, hypertensive nephrosclerosis, or chronic interstitial nephritis over the 20-year period. However, there was a significant increase in the percentage of blacks with FSGS, from 0% in 1975 to 1979 to 22.6% in 1990 to 1994, and an increased percentage of Hispanics with FSGS, from 0% in 1975 to 1979 to 21.3% in 1990 to 1994 (P < 0.05). The modest increase in whites with FSGS did not reach statistical significance. The incidence of MN in blacks and whites decreased over the 20-year period. In the last 5 years, 15 patients per year had FSGS compared with 7 patients per year with MN (P < 0.05). No changes in age or sex between groups or over time accounted for these results. We conclude that FSGS is now diagnosed twice as often as MN and is the most common idiopathic glomerular disease at our hospital. Reasons for this increase include the emergence of FSGS in both Hispanics and blacks, with a modest increase of FSGS in whites. The increase in FSGS in the three most common races in our community suggests that factors other than genetic, perhaps environmental, have a role in the pathogenesis of FSGS.
在大型都市医疗中心开展的研究报告称，成人特发性局灶节段性肾小球硬化（FSGS）的发病率呈上升趋势。为了确定在小型城市和农村社区是否也存在类似趋势，并确定种族在这些观察结果中的作用，我们回顾了1974年至1994年这20年间在我们机构接受肾活检的所有成人患者的病历。患者按5年间隔分组进行分析，即1975年至1979年、1980年至1984年、1985年至1989年以及1990年至1994年，诊断结果包括：FSGS、膜性肾病（MN）、微小病变性肾病（MCN）、膜增生性肾小球肾炎（MPGN）、免疫球蛋白A（IgA）肾病、慢性肾小球肾炎、糖尿病肾病、高血压性肾硬化以及慢性间质性肾炎。排除有这些病变继发原因的患者。FSGS的相对频率从1975年至1979年的13.7%增至1990年至1994年的25%（P<0.05）。MN的相对频率从1975年至1979年的38.3%降至1990年至1994年的14.5%（P<0.01）。在这20年期间，MCN、MPGN、IgA肾病、慢性肾小球肾炎、糖尿病肾病、高血压性肾硬化或慢性间质性肾炎的频率没有变化。然而，FSGS患者中黑人的比例显著增加，从1975年至1979年的0%增至1990年至1994年的22.6%，FSGS患者中西班牙裔的比例也有所增加，从1975年至1979年的0%增至1990年至1994年的21.3%（P<0.05）。FSGS患者中白人的适度增加未达到统计学意义。20年间，黑人和白人中MN的发病率均有所下降。在最后5年中，每年有15例患者患有FSGS，而每年有7例患者患有MN（P<0.05）。各组之间或随时间推移，年龄或性别均无变化可解释这些结果。我们得出结论，目前FSGS的诊断率是MN的两倍，是我们医院最常见的特发性肾小球疾病。这种增加的原因包括西班牙裔和黑人中FSGS的出现，以及白人中FSGS的适度增加。我们社区中三个最常见种族中FSGS的增加表明，除了遗传因素外，可能还有环境因素在FSGS的发病机制中起作用。
