肾功能在系统性硬化症患者中大多得以保留。

Renal function is mostly preserved in patients with systemic sclerosis.

机构信息

Department of Rheumatology, University Hospital, Lund, Sweden.

出版信息

Scand J Rheumatol. 2009;38(4):295-8. doi: 10.1080/03009740802629424.

DOI:10.1080/03009740802629424

PMID:19214870

Abstract

OBJECTIVE

Chronic renal disease other than scleroderma renal crisis (SRC) is not well documented in systemic sclerosis (SSc). We examined the occurrence of decreased glomerular filtration rate (GFR) in a large consecutive SSc cohort and analysed whether it was related to SSc or could be related to other causes.

METHODS

During 1983-2004 GFR was measured by chromium-51-ethylenediaminetetraacetic acid (51Cr-EDTA) or iohexol clearance in 461 patients with SSc according to the American College of Rheumatology (ACR) criteria [356 with limited cutaneous SSc (lcSSc) and 105 with diffuse cutaneous SSc (dcSSc)] and the measurements were repeated once a year. Decreased GFR was defined as GFR<70% of the age-adjusted values. SRC was diagnosed in 4/360 lcSSc (1.1%) and in 10/115 dcSSc (8.7%). These patients were excluded from further analyses.

RESULTS

At the latest follow-up at a median duration of 7.7 (range 0.5-54) years, decreased GFR was found in 39 lcSSc (11%) and nine (8.6%) dcSSc patients. Among the 48 SSc patients with GFR< 70p% (percentage of predicted value = p%), hypertension was diagnosed in 29 (60%) and cardiac involvement in 25 (52%). Different nephropathies were found in eight (19%) patients by renal biopsy. Fifteen patients with decreased GFR were followed up for > or = 4 years and no progress was seen in 11/15.

CONCLUSIONS

A minority of patients with SSc develop renal dysfunction other than SRC. Decreased GFR was associated with other manifestations such as hypertension and cardiac involvement indicating possible pre-renal causes.

摘要

目的

硬皮病肾危象（SRC）以外的慢性肾病在系统性硬化症（SSc）中记录甚少。我们检测了大量连续 SSc 患者中肾小球滤过率（GFR）降低的发生率，并分析其是否与 SSc 有关，或者是否可能与其他原因有关。

方法

根据美国风湿病学会（ACR）标准[356 例局限性皮肤型 SSc（lcSSc）和 105 例弥漫性皮肤型 SSc（dcSSc）]，1983-2004 年间对 461 例 SSc 患者进行了铬-51-乙二胺四乙酸（51Cr-EDTA）或碘海醇清除率的检测，每年重复一次。将 GFR 降低定义为 GFR<70%的年龄校正值。在 360 例 lcSSc 中发现了 4 例（1.1%）SRC，在 115 例 dcSSc 中发现了 10 例（8.7%）。这些患者被排除在进一步的分析之外。

结果

在中位随访时间为 7.7 年（范围 0.5-54 年）时，39 例 lcSSc（11%）和 9 例（8.6%）dcSSc 患者发现 GFR 降低。在 48 例 GFR<70p%（预测值的百分比 = p%）的 SSc 患者中，29 例（60%）诊断为高血压，25 例（52%）有心脏受累。8 例（19%）患者经肾活检发现不同的肾病。15 例 GFR 降低的患者随访>或=4 年，其中 11 例无进展。