Wakai S, Magil A B
Department of Pathology, University of British Columbia, Vancouver, Canada.
Kidney Int. 1992 Feb;41(2):428-34. doi: 10.1038/ki.1992.59.
The significance of the finding of focal glomerulosclerosis (FGS) in idiopathic membranous glomerulonephritis (MGN) is uncertain. Twenty-seven patients with mixed FGS and MGN (MGN-FGS) were compared to 25 patients with MGN alone (generally matched for age, sex and stage of glomerular lesion) with respect to pathology, presenting clinical and laboratory features, and course of disease. Biopsies from the MGN-FGS patients showed significantly more extensive tubulointerstitial disease (P less than 0.001) than did those with MGN alone. At the time of biopsy, the MGN-FGS group had a significantly higher proportion of patients with hypertension (P = 0.006) and microhematuria (P = 0.006), a marginally higher percentage of patients with the nephrotic syndrome (P = 0.051), and a greater mean 24-hour urinary protein excretion (P = 0.004). A similar proportion of patients in each group were treated with either prednisone alone or prednisone with an immunosuppressive. Forty-eight percent of MGN-FGS patients and 13% of the MGN patients developed established renal failure in the follow-up period (P = 0.008). The renal survival rate for the MGN-FGS group was significantly lower at 24 months (0.61 vs. 0.93, P less than 0.05), 60 months (0.48 vs. 0.88, P less than 0.025), and over the entire follow-up period (P less than 0.05). The results indicate that FGS in MGN is associated with a significantly poorer prognosis than MGN without this lesion.
局灶性肾小球硬化（FGS）在特发性膜性肾小球肾炎（MGN）中的发现意义尚不明确。将27例合并FGS和MGN（MGN - FGS）的患者与25例单纯MGN患者（一般在年龄、性别和肾小球病变阶段相匹配）在病理学、临床表现和实验室特征以及病程方面进行比较。MGN - FGS患者的活检显示，与单纯MGN患者相比，肾小管间质疾病明显更广泛（P < 0.001）。在活检时，MGN - FGS组高血压患者（P = 0.006）和镜下血尿患者（P = 0.006）的比例显著更高，肾病综合征患者的比例略高（P = 0.051），24小时尿蛋白平均排泄量更大（P = 0.004）。每组中相似比例的患者单独使用泼尼松或泼尼松联合免疫抑制剂进行治疗。在随访期间，48%的MGN - FGS患者和13%的MGN患者发展为终末期肾衰竭（P = 0.008）。MGN - FGS组在24个月时的肾脏存活率显著较低（0.61对0.93，P < 0.05），60个月时（0.48对0.88，P < 0.025），以及在整个随访期间（P < 0.05）。结果表明，MGN中的FGS与无此病变的MGN相比，预后明显更差。
