Chacko Bobby, John George T, Neelakantan Nithya, Korula Anila, Balakrishnan Narasimhan, Kirubakaran Meshach G, Jacob Chakko K
Department of Nephrology, Christian medical college, Vellore, India.
Nephrology (Carlton). 2005 Oct;10(5):496-503. doi: 10.1111/j.1440-1797.2005.00445.x.
IgA nephropathy (IgAN) is not well characterized in India. This retrospective study of 478 patients with IgAN was performed to clarify the presenting features, prognostic factors and the renal survival rates of the disease.
Three hundred and forty-seven patients who had been followed on average for 27 months after diagnosis were divided into two groups based on renal function at diagnosis. In group 1 (229 patients), the creatinine clearance estimated by the Modification of Diet in Renal Disease formula was <85 mL/min and in group 2 (118 patients) it was >/=85 mL/min.
The predominant modes of presentation were nephrotic syndrome, hypertension and renal failure. Twenty-nine percent of patients had more than a 20% decline in renal function at the last follow up. Multivariate analyses with stepwise logistic regression identified hypertension (odds ratio (OR) 3.5), nephrotic range proteinuria (OR 3.4) and sclerosed glomeruli on biopsy (OR 4.1) to be independently associated with progression in group 1 and hypertension (OR 2.3) in group 2. Seventeen percent of patients progressed to end-stage renal disease (ESRD). Using multivariate analysis by the Cox model, four risk factors for developing ESRD were identified: hypertension (hazard ratio (HR) 3.1); nephrotic proteinuria (HR 1.9); interstitial fibrosis (HR 2.5); and sclerosed glomeruli (HR 1.8). The renal survival rates at 1, 5 and 10 years were 84, 55 and 33%, respectively, with a median renal survival of 61 months from the time of biopsy.
The relatively rapid rate of progression of IgAN in India is suggestive towards a 'malignant' nature of the disease in this country.
在印度，IgA 肾病（IgAN）的特征尚未得到充分描述。本项对 478 例 IgAN 患者的回顾性研究旨在明确该疾病的临床表现、预后因素及肾脏生存率。
347 例诊断后平均随访 27 个月的患者，根据诊断时的肾功能分为两组。第 1 组（229 例患者），根据肾脏病饮食改良公式估算的肌酐清除率<85 mL/分钟；第 2 组（118 例患者），肌酐清除率≥85 mL/分钟。
主要的表现形式为肾病综合征、高血压和肾衰竭。29%的患者在最后一次随访时肾功能下降超过 20%。逐步逻辑回归的多变量分析确定，第 1 组中高血压（比值比（OR）3.5）、肾病范围蛋白尿（OR 3.4）和活检时硬化肾小球（OR 4.1）与疾病进展独立相关，第 2 组中高血压（OR 2.3）与疾病进展独立相关。17%的患者进展至终末期肾病（ESRD）。通过 Cox 模型进行多变量分析，确定了发生 ESRD 的四个危险因素：高血压（风险比（HR）3.1）；肾病性蛋白尿（HR 1.9）；间质纤维化（HR 2.5）；硬化肾小球（HR 1.8）。从活检时起，1 年、5 年和 10 年的肾脏生存率分别为 84%﹑55%和 33%，肾脏生存中位数为 61 个月。
印度 IgAN 相对较快的进展速度提示该国该疾病具有“恶性”本质。
Zotero 插件