Swaminathan Sundararaman, Leung Nelson, Lager Donna J, Melton L Joseph, Bergstralh Eric J, Rohlinger Audrey, Fervenza Fernando C
Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
Clin J Am Soc Nephrol. 2006 May;1(3):483-7. doi: 10.2215/CJN.00710805. Epub 2006 Apr 19.
Membranous nephropathy (MN) is considered the most common cause of nephrotic syndrome in white adults, but recent studies have shown an increasing incidence of focal segmental glomerulosclerosis (FSGS). These studies are difficult to interpret because the majority of cases came from urban tertiary referral centers. For validating these findings in the general population, trends in the incidence of various forms of glomerular disease (glomerulonephritis [GN]) among the residents of Olmsted County, MN were studied. Biopsy data of local patients who had a diagnosis of a nondiabetic glomerular disease from 1974 through 2003 were reviewed. Biopsies were categorized as (1) FSGS, (2) MN, (3) minimal change, (4) lupus nephritis, (5) membranoproliferative GN (MPGN), (6) IgA nephropathy (IgAN), (7) crescentic/necrotizing GN, and (8) other. Time trends in the annual age- and gender-adjusted (2000 US population) incidence rate per 100,000 Olmsted County population were estimated. A total of 195 biopsies were analyzed. Overall, IgAN was present in 22%, FSGS was present in 17%, and MN was present in 10%. Between 1974 to 1983 and 1994 to 2003, the incidence of any type of GN among Olmsted County residents increased more than two-fold (P < 0.001), FSGS by 13-fold (P < 0.001), and IgAN by three-fold (P = 0.002). Increases in MN were nonsignificant (2.5-fold; P = 0.13). Currently (1994 to 2003), the most frequent type of GN is IgAN (25%), followed by FSGS (20%) and MN (11%), with annual incidence rates of 2.1, 1.8, and 1.0 per 100,000/yr, respectively. This study confirms that the incidence of GN is growing overall, particularly for FSGS, which is the leading cause of nephrotic syndrome in white adults.
膜性肾病（MN）被认为是白人成年人肾病综合征最常见的病因，但最近的研究表明局灶节段性肾小球硬化症（FSGS）的发病率在上升。由于大多数病例来自城市三级转诊中心，这些研究结果难以解读。为了在普通人群中验证这些发现，我们研究了明尼苏达州奥尔姆斯特德县居民中各种形式肾小球疾病（肾小球肾炎[GN]）的发病率趋势。回顾了1974年至2003年当地诊断为非糖尿病性肾小球疾病患者的活检数据。活检分为以下几类：（1）FSGS，（2）MN，（3）微小病变，（4）狼疮性肾炎，（5）膜增生性肾小球肾炎（MPGN），（6）IgA肾病（IgAN），（7）新月体/坏死性肾小球肾炎，以及（8）其他。估计了奥尔姆斯特德县每10万人口按年龄和性别调整（2000年美国人口）后的年发病率的时间趋势。总共分析了195份活检样本。总体而言，IgAN占22%，FSGS占17%，MN占10%。在1974年至1983年与1994年至2003年期间，奥尔姆斯特德县居民中任何类型GN的发病率增加了两倍多（P < 0.001），FSGS增加了13倍（P < 0.001），IgAN增加了三倍（P = 0.002）。MN的增加不显著（2.5倍；P = 0.13）。目前（1994年至2003年），最常见的GN类型是IgAN（25%），其次是FSGS（20%）和MN（11%），年发病率分别为每10万/年2.1、1.8和1.0。这项研究证实GN的发病率总体上在上升，尤其是FSGS，它是白人成年人肾病综合征的主要病因。
