Lai F M, Szeto C C, Choi P C, Li P K, Chan A W, Tang N L, Lui S F, Wang A Y, To K F
Departments of Anatomical and Cellular Pathology, Medicine and Therapeutics, and Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong,
Am J Kidney Dis. 2000 Oct;36(4):703-8. doi: 10.1053/ajkd.2000.17614.
Histological grading of 45 patients with clinical early immunoglobulin A (IgA) nephropathy was correlated with disease progression over a median follow-up of 123 months. Clinical early IgA nephropathy was defined as a serum creatinine level of 1.3 mg/dL or less, proteinuria of 0.4 g/d or less of protein, and the absence of hypertension at the time of renal biopsy. Disease progression was related to the occurrence of impaired renal function, increased proteinuria, and hypertension. We applied a previously described chronicity-based histological grading to the renal biopsy specimen and also assessed acute glomerular lesions. Disease progression was observed in 44.4% of these patients. Forty patients (89%) showed glomerular grade 1 (GG1) and 5 patients (11%) showed GG2, but this grading did not correlate with disease progression. However, when GG1 was subdivided into GG1a (mean sclerosis per glomerulus <10%) and GG1b (mean sclerosis per glomerulus 10% to <25%), GG1a correlated with nonprogressive disease. Tubulointerstitial grade also correlated with disease progression but was associated with a low sensitivity for predicting nonprogressive disease. Hyaline arteriolosclerosis and acute glomerular lesions did not correlate with disease progression. The chronicity-based histological grading is not only applicable to clinical early IgA nephropathy, but also more importantly, it characterizes GG1a in a subset of patients with a very low risk for disease progression, which can be regarded as genuine early IgA nephropathy.
对45例临床早期免疫球蛋白A（IgA）肾病患者进行组织学分级，并与中位随访123个月期间的疾病进展情况进行关联分析。临床早期IgA肾病定义为肾活检时血清肌酐水平为1.3mg/dL或更低、蛋白尿为0.4g/d或更低且无高血压。疾病进展与肾功能受损、蛋白尿增加及高血压的发生有关。我们对肾活检标本应用了先前描述的基于慢性病变的组织学分级方法，并评估了急性肾小球病变。这些患者中44.4%出现疾病进展。40例患者（89%）表现为肾小球1级（GG1），5例患者（11%）表现为GG2，但这种分级与疾病进展无关。然而，当将GG1细分为GG1a（每个肾小球平均硬化<10%）和GG1b（每个肾小球平均硬化10%至<25%）时，GG1a与疾病无进展相关。肾小管间质分级也与疾病进展相关，但对预测疾病无进展的敏感性较低。玻璃样小动脉硬化和急性肾小球病变与疾病进展无关。基于慢性病变的组织学分级不仅适用于临床早期IgA肾病，更重要的是，它在一部分疾病进展风险极低的患者中对GG1a进行了特征描述，这部分患者可被视为真正的早期IgA肾病。
