Department of Nephrology, Traditional Chinese Internal Medicine e-Institute of Shanghai University, ShuGuang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, PR China.
J Investig Med. 2010 Mar;58(3):560-5. doi: 10.231/JIM.0b013e3181d20aa1.
Many patients with immunoglobulin class A (IgA) nephropathy (IgAN) present with asymptomatic urinary abnormalities. The purpose of this study was to observe the clinicopathological characteristics and prognostic factors in asymptomatic IgAN.
Eighty-six asymptomatic IgAN patients (49 males and 37 females) were investigated; 82 of them were followed up during a mean +/- SD period of 66.7 +/- 19.7 months.
At biopsy, 18 patients (21%) presented with pure hematuria (HU), 29 patients (34%) presented with proteinuria alone (PU), and 39 patients (45%) presented concomitant hematuria and proteinuria with severe pathological lesions. Meanwhile, 16% and 26% had renal insufficiency and hypertension, respectively. Finally, urinary abnormalities of 15% of the patients disappeared, 25% of HU developed proteinuria, 47% of concomitant hematuria and proteinuria, and 32% of PU appeared to have increase of proteinuria, and 14% of PU developed hematuria. Fifteen (24%) of the patients with normal blood pressure initially became hypertensive and 18 (22%) of the patients with normal renal function initially developed renal insufficiency. Twenty-four patients (29%) had doubling of serum creatinine level, and 13 patients (16%) progressed to end-stage renal disease. Prednisone therapy and antihypertensive treatment significantly improved proteinuria and renal function deterioration. Hematuria, hypertension during follow-up, and tubulointerstitial lesions were independent risk factors predictive of the ultimate development of renal progression.
The renal outcome of asymptomatic IgAN is guarded. Hematuria, hypertension during follow-up, and tubulointerstitial lesions may be important markers to monitor renal progression in the course.
许多免疫球蛋白 A (IgA) 肾病 (IgAN) 患者表现为无症状性尿异常。本研究旨在观察无症状 IgAN 的临床病理特征和预后因素。
研究纳入 86 例无症状 IgAN 患者（男 49 例，女 37 例），平均随访时间为 66.7±19.7 个月。
在活检时，18 例（21%）患者表现为单纯血尿（HU），29 例（34%）患者表现为单纯蛋白尿（PU），39 例（45%）患者同时存在血尿和蛋白尿且病理损伤严重。同时，16%和 26%的患者分别存在肾功能不全和高血压。最终，15%的患者尿异常消失，25%的 HU 患者出现蛋白尿，47%的同时存在血尿和蛋白尿的患者蛋白尿增加，32%的 PU 患者蛋白尿增加，14%的 PU 患者出现血尿。15 例（24%）最初血压正常的患者发展为高血压，18 例（22%）最初肾功能正常的患者发展为肾功能不全。24 例（29%）患者血清肌酐水平倍增，13 例（16%）患者进展至终末期肾病。泼尼松治疗和降压治疗可显著改善蛋白尿和肾功能恶化。随访期间的血尿、高血压和肾小管间质病变是预测肾脏进展的独立危险因素。
无症状 IgAN 的肾脏预后不佳。血尿、随访期间的高血压和肾小管间质病变可能是监测疾病进展的重要标志物。
