El-Reshaid W, El-Reshaid K, Kapoor M M, Madda J P
Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait.
Ren Fail. 2003 Jul;25(4):619-30. doi: 10.1081/jdi-120022554.
There are few studies that examine, prospectively, the epidemiological profile of glomerulopathy (GP) and its clinicopathological correlation. All patients referred to Al-Amiri renal center in Kuwait from January 1st, 1995 to December 31st, 2001 were screened for GP. Detailed clinical data were collected and serological markers were done. Renal biopsy was performed whenever indicated. During those 7 years, a total of 584 patients were diagnosed, on histological basis, to have GP, 315 of whom were Kuwaiti nationals. During the same period of the study, 26 patients presented with bilateral small kidneys, history of proteinuria > 2 g/day and lacked systemic manifestations of autoimmune disease. Furthermore, 164 patients with clinical manifestations of diabetic glomerulosclerosis were not subjected to kidney biopsy. Hence, the calculated annual incidence rate of GP in Kuwaiti nationals was 34.5 per 100,000 population (PTP). The calculated rate of diabetic glomerulosclerosis was 13.4 PTP and that of nondiabetic 21.1 PTP. The calculated incidence rates of GP increased with age and were twice as high in males compared to females. Vasculitis was more common in elderly males while SLE nephritis was a disease of adults, 88.7% of whom were females. In the subgroup of primary GP, focal segmental glomerulosclerosis was the most common histological lesion accounting for 18.0% of the total biopsies in Kuwaiti patients, yet only 36.8% of those who fulfilled the criteria of primary type. Minimal change disease was the second primary GP (13.0%), followed by immunoglobulin A deposition disease (7.9%) and membranous glomerulonephritis (5%). Autoimmune diseases such as systemic lupus erythematosus (SLE) and vasculitis were common. Interestingly, only 44 of 72 (61.1%) of patients with SLE and 11 of the 62 (17.7%) of patients with vasculitis presented with rapidly progressive glomerulonephritis. On the other hand, 10 of 58 (17.2%) patients with nephroangiosclerosis presented with renal failure and protein excretion > 2 g/day simulating primary GP. Furthermore, only 21 of 40 (52.5%) patients with IgA nephropathy presented with "benign disease". Prospective studies are essential to ascertain the actual incidence and etiology of GP. The loose clinicopathological correlation in GP dictates an aggressive diagnostic approach in its study and management.
很少有研究前瞻性地调查肾小球病（GP）的流行病学概况及其临床病理相关性。对1995年1月1日至2001年12月31日转诊至科威特Al-Amiri肾脏中心的所有患者进行了GP筛查。收集了详细的临床数据并进行了血清学检测。在必要时进行肾活检。在这7年中，共有584例患者经组织学诊断患有GP，其中315例为科威特公民。在研究的同一时期，有26例患者表现为双侧小肾脏、蛋白尿>2 g/天且无自身免疫性疾病的全身表现。此外，164例有糖尿病肾小球硬化临床表现的患者未接受肾活检。因此，科威特公民中GP的计算年发病率为每10万人口34.5例（PTP）。糖尿病肾小球硬化的计算发病率为13.4 PTP，非糖尿病的为21.1 PTP。GP的计算发病率随年龄增加，男性是女性的两倍。血管炎在老年男性中更常见，而狼疮性肾炎是成年人的疾病，其中88.7%为女性。在原发性GP亚组中，局灶节段性肾小球硬化是最常见的组织学病变，占科威特患者活检总数的18.0%，但仅占符合原发性类型标准患者的36.8%。微小病变病是第二常见的原发性GP（13.0%），其次是免疫球蛋白A沉积病（7.9%）和膜性肾小球肾炎（5%）。自身免疫性疾病如系统性红斑狼疮（SLE）和血管炎很常见。有趣的是，72例SLE患者中只有44例（61.1%）和62例血管炎患者中只有11例（17.7%）表现为快速进展性肾小球肾炎。另一方面，58例肾血管硬化患者中有10例（17.2%）表现为肾衰竭且蛋白排泄>2 g/天，类似于原发性GP。此外，40例IgA肾病患者中只有21例（52.5%）表现为“良性疾病”。前瞻性研究对于确定GP的实际发病率和病因至关重要。GP中临床病理相关性松散决定了在其研究和管理中采取积极的诊断方法。
