Woo K T, Lau Y K, Lee G S, Wei S S, Lim C H
Department of Renal Medicine, Singapore General Hospital, Republic of Singapore.
Clin Nephrol. 1991 Jul;36(1):6-11.
Of sixty patients with IgA nephritis, none had CRF at first examination, 13 developed CRF with creatinine above 1.6 mg/dl within 6 years. Among these patients who had analysis of proteinuria by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE), 31 patients had middle molecular weight (MMW) proteinuria alone (pattern 1), 10 had MMW and Low MW (LMW) or tubular proteinuria (pattern 2), 10 had high MW (HMW) and MMW proteinuria (Pattern 3) and 9 had HMW, MMW and LMW proteinuria (Pattern 4). At the end of a follow up period of 6 years (1983-1989) patients with mixed proteinuria had a higher incidence of chronic renal failure (CRF), 11/29 (38%) compared to those with pattern 1 proteinuria, 2/31 (6%) (chi 2 = 8.7, p less than 0.005). Based on the glomerular selectivity index (GSI), 19 patients had nonselective proteinuria but they did not have a higher incidence of CRF. By the selectivity index (SI), 18 patients had nonselective proteinuria and they showed a significantly higher incidence of CRF. Compared to the 41 patients who did not have LMW proteinuria, 19 patients with LMW proteinuria had more severe proteinuria. After a follow-up period of 6 years, patients with LMW proteinuria had a higher incidence of CRF (10% versus 47%, p less than 0.001). The presence of LMW proteinuria indicates a less favourable outcome and the pattern of proteinuria as assessed by the SDS-PAGE appears to be a better prognostic index in IgA nephritis than the SI and the GSI.
在60例IgA肾病患者中，初次检查时均无慢性肾衰竭（CRF），13例在6年内血肌酐超过1.6mg/dl发展为CRF。在这些通过十二烷基硫酸钠聚丙烯酰胺凝胶电泳（SDS-PAGE）分析蛋白尿的患者中，31例仅有中分子量（MMW）蛋白尿（模式1），10例有MMW和低分子量（LMW）或肾小管性蛋白尿（模式2），10例有高分子量（HMW）和MMW蛋白尿（模式3），9例有HMW、MMW和LMW蛋白尿（模式4）。在6年（1983 - 1989年）的随访期结束时，混合性蛋白尿患者的慢性肾衰竭（CRF）发生率较高，为11/29（38%），而模式1蛋白尿患者为2/31（6%）（χ2 = 8.7，p < 0.005）。基于肾小球选择性指数（GSI），19例患者有非选择性蛋白尿，但他们的CRF发生率并未升高。根据选择性指数（SI），18例患者有非选择性蛋白尿，且他们的CRF发生率显著更高。与41例无LMW蛋白尿的患者相比，19例有LMW蛋白尿的患者蛋白尿更严重。经过6年的随访期，有LMW蛋白尿的患者CRF发生率更高（10%对47%，p < 0.001）。LMW蛋白尿的存在表明预后较差，通过SDS-PAGE评估的蛋白尿模式在IgA肾病中似乎比SI和GSI是更好的预后指标。
