Manno Carlo, Strippoli Giovanni F M, D'Altri Christian, Torres Diletta, Rossini Michele, Schena Francesco P
Department of Emergency and Organ Transplantation, Renal, Dialysis and Transplant Unit, University of Bari, Bari, Italy.
Am J Kidney Dis. 2007 Jun;49(6):763-75. doi: 10.1053/j.ajkd.2007.03.013.
Patients with immunoglobulin A (IgA) nephropathy may progress to end-stage renal disease (ESRD) within 10 to 20 years after renal biopsy. We evaluated factors associated with long-term renal survival by using a novel simplified histological classification.
Retrospective study.
SETTING & PARTICIPANTS: 437 patients (296 men, 141 women) with IgA nephropathy seen at our single center from January 1971 to December 2006. Most patients received treatment with renin-angiotensin system inhibitors.
Baseline age, sex, presence of hematuria, presence of hypertension, serum creatinine level, urine protein at baseline, and 2 histological classifications.
OUTCOMES & MEASUREMENTS: Relationship of baseline factors to time to ESRD was evaluated by means of univariate and multivariate analysis with log-rank test and the Cox proportional hazard method.
In a mean follow-up of 107.6 months, 72 ESRD events occurred. The 5-, 10-, 15-, and 20-year renal survival rates after renal biopsy were 94.1%, 82.1%, 73.1%, and 60.3%, respectively. Independent baseline predictors of increased ESRD risk were microhematuria with absence of recurrent macrohematuria (adjusted hazard ratio [HR], 2.18; 95% confidence interval [CI], 1.30 to 3.65; P = 0.003), 1.0 mg/dL (88.4 mumol/L) higher serum creatinine level (HR, 1.50; 95% CI, 1.10 to 2.07; P = 0.013), proteinuria with 1.0 g/dL (10.0 g/L) greater protein (HR, 1.28; 95% CI, 1.07 to 1.52; P = 0.006), and grading of histological lesions. A 1-grade increase according to our 3-grade classification was associated with a nearly 6-fold ESRD risk increase (adjusted HR, 5.95; 95% CI, 3.54 to 10.01; P < 0.0001).
Lack of adjustment for changes in treatment that may have occurred during the study period.
Renal damage progression in patients with IgA nephropathy was associated with microscopic hematuria at clinical onset, increased serum creatinine level, increased proteinuria, and grading of histological lesions. Our classification system appears simpler than other classifications and is associated with ESRD risk, which could help identify individual high-risk patients and stratify patients enrolled in randomized clinical trials into homogeneous groups.
免疫球蛋白A（IgA）肾病患者在肾活检后10至20年内可能进展为终末期肾病（ESRD）。我们使用一种新型简化组织学分类评估了与长期肾脏生存相关的因素。
回顾性研究。
1971年1月至2006年12月在我们单中心就诊的437例IgA肾病患者（296例男性，141例女性）。大多数患者接受了肾素 - 血管紧张素系统抑制剂治疗。
基线年龄、性别、血尿的存在、高血压的存在、血清肌酐水平、基线时尿蛋白以及两种组织学分类。
通过单因素和多因素分析，采用对数秩检验和Cox比例风险法评估基线因素与至ESRD时间的关系。
平均随访107.6个月，发生72例ESRD事件。肾活检后5年、10年、15年和20年的肾脏生存率分别为94.1%、82.1%、73.1%和60.3%。ESRD风险增加的独立基线预测因素为无复发性肉眼血尿的镜下血尿（校正风险比[HR]，2.18；95%置信区间[CI]，1.30至3.65；P = 0.003）、血清肌酐水平每升高1.0 mg/dL（88.4 μmol/L）（HR，1.50；95% CI，1.10至2.07；P = 0.013）、蛋白尿每增加1.0 g/dL（10.0 g/L）（HR，1.28；95% CI，1.07至1.52；P = 0.006）以及组织学病变分级。根据我们的三级分类，分级增加1级与ESRD风险增加近6倍相关（校正HR，5.95；95% CI，3.54至10.01；P < 0.0001）。
未对研究期间可能发生的治疗变化进行调整。
IgA肾病患者的肾损害进展与临床发病时的镜下血尿、血清肌酐水平升高、蛋白尿增加以及组织学病变分级相关。我们的分类系统似乎比其他分类更简单，且与ESRD风险相关，这有助于识别个体高危患者，并将参与随机临床试验的患者分层为同质组。
