Weber Catherine L, Rose Caren L, Magil Alex B
Division of Nephrology, Department of Medicine, University of British Columbia, Canada.
Nephrol Dial Transplant. 2009 Feb;24(2):483-8. doi: 10.1093/ndt/gfn513. Epub 2008 Sep 11.
The significance of focal segmental glomerulosclerosis (FSGS) in mild IgA nephropathy is uncertain.
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.
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.
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.
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。
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。
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。
我们的研究表明，轻度IgA肾病患者的局灶节段性肾小球硬化病变及相关临床和病理表现与更差的肾脏结局相关。
