轻度IgA肾病中的局灶节段性肾小球硬化：一项临床病理研究。

Focal segmental glomerulosclerosis in mild IgA nephropathy: a clinical-pathologic study.

作者信息

Weber Catherine L, Rose Caren L, Magil Alex B

机构信息

Division of Nephrology, Department of Medicine, University of British Columbia, Canada.

出版信息

Nephrol Dial Transplant. 2009 Feb;24(2):483-8. doi: 10.1093/ndt/gfn513. Epub 2008 Sep 11.

DOI:10.1093/ndt/gfn513

PMID:18786972

Abstract

BACKGROUND

The significance of focal segmental glomerulosclerosis (FSGS) in mild IgA nephropathy is uncertain.

METHODS

All consecutive renal biopsies performed between 1996 and 2005 in adults with a diagnosis of mild IgA nephropathy (Lee Grade 1 or 2) at St Paul's Hospital, Vancouver, Canada, were reviewed.

RESULTS

Seventy-five patients were included, 26 (35%) with IgA nephropathy and FSGS (FSGS+ group) and 49 (65%) with IgA nephropathy without FSGS (FSGS- group). The mean follow-up was 3 years. At the time of renal biopsy the FSGS+ group had a lower eGFR (60 versus 73 mL/min, P = 0.02), lower serum albumin (38 versus 41 g/L, P = 0.02), higher mean arterial pressure (103 versus 97 mmHg, P = 0.03) and greater protein excretion (3.0 versus 1.3 g/day, P < 0.01) than the FSGS- group. On histology, the FSGS+ group had a higher percentage of obsolete glomeruli (23.4% versus 12.7%, P < 0.01), and 31% of FSGS+ biopsies had >or=25% tubular atrophy/interstitial fibrosis while this was not observed in the FSGS- group (P < 0.01). The primary outcome measure, DeltaGFR, was -2.56 mL/ min/year in the FSGS+ group and +1.14 mL/min/year in the FSGS- group, difference: 3.70 mL/min/year (P = 0.03) (univariate). In the multivariate model, the FSGS+ group declined at 0.19 mL/min/year (-14.16, 13.78) and the FSGS- group improved at 2.85 mL/min/year (-11.64, 17.34), difference 3.04 mL/min/year, P = 0.18.

CONCLUSIONS

Our study suggests that the focal segmental glomerulosclerosis lesion and associated clinical and pathologic findings in patients with mild IgA nephropathy are associated with a worse renal outcome.

摘要

背景

局灶节段性肾小球硬化（FSGS）在轻度IgA肾病中的意义尚不确定。

方法

回顾了1996年至2005年间在加拿大温哥华圣保罗医院对诊断为轻度IgA肾病（Lee分级1级或2级）的成人进行的所有连续肾活检。

结果

共纳入75例患者，26例（35%）为IgA肾病合并FSGS（FSGS+组），49例（65%）为IgA肾病不合并FSGS（FSGS-组）。平均随访3年。肾活检时，FSGS+组的估算肾小球滤过率（eGFR）较低（60对73 mL/分钟，P = 0.02），血清白蛋白较低（38对41 g/L，P = 0.02），平均动脉压较高（103对97 mmHg，P = 0.03），蛋白尿排泄量更大（3.0对1.3 g/天，P < 0.01）。组织学上，FSGS+组废弃肾小球的比例更高（23.4%对12.7%，P < 0.01），31%的FSGS+肾活检标本有≥25%的肾小管萎缩/间质纤维化，而FSGS-组未观察到（P < 0.01）。主要结局指标，即肾小球滤过率变化量（DeltaGFR），FSGS+组为-2.56 mL/分钟/年，FSGS-组为+1.14 mL/分钟/年，差异：3.70 mL/分钟/年（P = 0.03）（单变量）。在多变量模型中，FSGS+组以0.19 mL/分钟/年的速度下降（-14.16，13.78），FSGS-组以2.85 mL/分钟/年的速度改善（-11.64，17.34），差异为3.04 mL/分钟/年，P = 0.18。