IgG 分数排泄率可预测原发性局灶节段性肾小球硬化的肾脏预后及治疗反应：一项初步研究。

Fractional excretion of IgG predicts renal outcome and response to therapy in primary focal segmental glomerulosclerosis: a pilot study.

作者信息

Bazzi Claudio, Petrini Concetta, Rizza Virginia, Napodano Pietro, Paparella Maria, Arrigo Girolamo, Pisano Lucia, D'Amico Giuseppe

机构信息

Division of Nephrology and Dialysis, Biochemical Laboratory, San Carlo Borromeo Hospital, Milan, Italy.

出版信息

Am J Kidney Dis. 2003 Feb;41(2):328-35. doi: 10.1053/ajkd.2003.50040.

DOI:10.1053/ajkd.2003.50040

PMID:12552493

Abstract

BACKGROUND

Prolonged treatment with steroids and/or cyclophosphamide improves the prognosis of primary focal segmental glomerulosclerosis (FSGS). In nephrotic patients, no clinical or histological feature predicts responsiveness to therapy.

METHODS

In 50 patients with FSGS, fractional excretion (FE) of immunoglobulin G (IgG), albumin, transferrin, and alpha(1)-microglobulin (alpha(1)m) was calculated. The aim of the study is to assess whether FE IgG and FE alpha(1)m: (1) correlate with histological lesions, (2) predict outcome, and (3) may be useful to guide therapy.

RESULTS

The association of FE IgG with percentage of glomeruli with segmental sclerosis was at the limit of significance (P = 0.01). FE alpha(1)m was associated with extent of tubulointerstitial damage (P = 0.008). By multiple regression analysis, FE alpha(1)m was dependent on FE IgG (R(2) = 0.76; P = 0.000). The predictive value of proteinuric variables on outcome was evaluated in 29 patients with nephrotic syndrome and baseline normal renal function (serum creatinine level, 1.04 +/- 0.22 mg/dL [92 +/- 19 micromol/L]; follow-up, 50 +/- 33 months); remission rates were 91% and 0% in patients with FE IgG less than versus greater than 0.140 (P = 0.0009). By multiple logistic regression analysis, only FE IgG was associated with remission (P = 0.043). Proteinuria less than versus greater than 7.5 g/d of protein predicted end-stage renal failure (0% versus 36%; P = 0.004); the predictive value of FE IgG less than versus greater than 0.140 was higher (0% versus 71%; P = 0.0000). Patients with FE IgG less than 0.025 were responsive to steroids alone (70%) or steroids and cyclophosphamide (20%); patients with FE IgG greater than 0.025 and less than 0.140 were responsive to steroids alone (20%) or steroids and cyclophosphamide (80%); and 100% of patients with FE IgG greater than 0.140 were unresponsive to therapy (P = 0.000).

CONCLUSION

In FSGS, FE IgG is at the limit of statistically significant association with segmental sclerosis, and FE alpha(1)m is associated with extent of tubulointerstitial damage. FE IgG shows the best predictive value for remission, progression, and response to therapy and may be useful to guide treatment. Am J Kidney Dis 41:328-335.

摘要

背景

长期使用类固醇和/或环磷酰胺治疗可改善原发性局灶节段性肾小球硬化（FSGS）的预后。在肾病患者中，没有临床或组织学特征可预测对治疗的反应性。

方法

计算50例FSGS患者免疫球蛋白G（IgG）、白蛋白、转铁蛋白和α1-微球蛋白（α1m）的分数排泄（FE）。本研究的目的是评估FE IgG和FE α1m是否：（1）与组织学病变相关，（2）预测预后，（3）可能有助于指导治疗。

结果

FE IgG与节段性硬化肾小球百分比的关联接近显著水平（P = 0.01）。FE α1m与肾小管间质损伤程度相关（P = 0.008）。通过多元回归分析，FE α1m依赖于FE IgG（R2 = 0.76；P = 0.000）。在29例肾病综合征且基线肾功能正常（血清肌酐水平，1.04±0.22 mg/dL [92±19 μmol/L]；随访，50±33个月）的患者中评估蛋白尿变量对预后的预测价值；FE IgG小于0.140与大于0.140的患者缓解率分别为91%和0%（P = 0.0009）。通过多元逻辑回归分析，只有FE IgG与缓解相关（P = 0.043）。蛋白尿小于7.5 g/d与大于7.5 g/d预测终末期肾衰竭（0%对36%；P = 0.004）；FE IgG小于0.140与大于0.140的预测价值更高（0%对71%；P = 0.0000）。FE IgG小于0.025的患者单独使用类固醇（70%）或类固醇和环磷酰胺（20%）有效；FE IgG大于0.025且小于0.140的患者单独使用类固醇（20%）或类固醇和环磷酰胺（80%）有效；FE IgG大于0.140的患者100%对治疗无反应（P = 0.000）。