Alexander Mariam P, Patel Tejas V, Farag Youssef M K, Florez Adriana, Rennke Helmut G, Singh Ajay K
Renal Division, Brigham and Women's Hospital, Boston, MA 02115, USA.
Am J Kidney Dis. 2009 May;53(5):751-9. doi: 10.1053/j.ajkd.2009.01.255. Epub 2009 Apr 1.
The worldwide prevalence of metabolic syndrome is increasing and has been associated with chronic kidney disease. Kidney pathological findings in patients with metabolic syndrome have not been well described, as was explored in this study.
Cross-sectional study.
SETTING & PARTICIPANTS: We retrospectively screened clinical information for 146 patients who underwent elective nephrectomy for renal cell carcinoma between January 2005 and March 2007 at Brigham and Women's Hospital, Boston, MA. Twelve patients with metabolic syndrome were identified. Twelve age- and sex-matched patients who did not have any of the criteria for metabolic syndrome were used as controls.
Presence of metabolic syndrome defined by using Adult Treatment Panel III criteria.
Histological characteristics in each group, decrease in kidney function at 1-year follow-up.
Two pathologists blinded to the clinical diagnosis independently evaluated nephrectomy specimens using Banff criteria to objectively assess histological characteristics.
Baseline characteristics were similar between the 2 groups. On histopathologic examination, patients with metabolic syndrome compared with controls had a greater prevalence of tubular atrophy (P = 0.006), interstitial fibrosis (P = 0.001), and arterial sclerosis (P = 0.001), suggesting microvascular disease. Patients with metabolic syndrome had greater global (P = 0.04) and segmental glomerulosclerosis (P = 0.05). Glomerular volume and cross-sectional surface area were not different. The combined end point of tubular atrophy greater than 5%, interstitial fibrosis greater than 5%, and presence of arterial sclerosis was more prevalent in patients with metabolic syndrome (P = 0.003; odds ratio, 33; confidence interval, 2.9 to 374.3) than controls. After 1 year, estimated glomerular filtration rate was significantly lower in patients with metabolic syndrome compared with controls (P = 0.03).
Small sample size, retrospective design.
We report a high prevalence of microvascular disease in patients with metabolic syndrome. There was a steeper decrease in kidney function over time in patients with metabolic syndrome, suggesting limited renal reserve. Aggressive screening and management may be warranted in patients with metabolic syndrome to protect kidney function.
代谢综合征在全球的患病率正在上升，并且与慢性肾脏病相关。本研究旨在探讨代谢综合征患者的肾脏病理表现，但此前相关描述并不充分。
横断面研究。
我们回顾性筛查了2005年1月至2007年3月期间在马萨诸塞州波士顿市布莱根妇女医院因肾细胞癌接受择期肾切除术的146例患者的临床信息。其中识别出12例代谢综合征患者。选取12例年龄和性别匹配且无代谢综合征任何标准的患者作为对照。
采用成人治疗小组III标准定义的代谢综合征。
每组的组织学特征，1年随访时肾功能的下降情况。
两名对临床诊断不知情的病理学家使用班夫标准独立评估肾切除标本，以客观评估组织学特征。
两组的基线特征相似。组织病理学检查显示，与对照组相比，代谢综合征患者肾小管萎缩（P = 0.006）、间质纤维化（P = 0.001）和动脉硬化（P = 0.001）的患病率更高，提示存在微血管疾病。代谢综合征患者的全球（P = 0.04）和节段性肾小球硬化（P = 0.05）更为严重。肾小球体积和横截面积无差异。代谢综合征患者中肾小管萎缩大于5%、间质纤维化大于5%和存在动脉硬化的联合终点比对照组更为常见（P = 0.003；比值比，33；置信区间，2.9至374.3）。1年后，代谢综合征患者的估计肾小球滤过率显著低于对照组（P = 0.03）。
样本量小，回顾性设计。
我们报告了代谢综合征患者中微血管疾病的高患病率。代谢综合征患者的肾功能随时间下降更为明显，提示肾储备有限。对于代谢综合征患者，可能需要积极的筛查和管理以保护肾功能。
