Department of Nephrology, Dialysis and Transplantation, A. Manzoni Hospital, Lecco, Italy.
Am J Kidney Dis. 2010 Sep;56(3):506-12. doi: 10.1053/j.ajkd.2010.03.033.
Whether pregnancy impacts on the long-term outcome of immunoglobulin A (IgA) nephropathy is unknown. This study aims to compare the long-term outcome of kidney disease in women with IgA nephropathy and preserved kidney function who did and did not become pregnant.
Multicenter longitudinal cohort study.
SETTING & PARTICIPANTS: Women of childbearing age with biopsy-proven IgA nephropathy, serum creatinine level<or=1.2 mg/dL at diagnosis, and minimum follow-up of 5 years after biopsy recruited from 35 nephrology centers participating in a national collaborative study group of pregnancy and kidney disease sponsored by the Italian Society of Nephrology.
Pregnancy, treated as a time-dependent variable; baseline proteinuria; hypertension; and kidney biopsy histologic characteristics.
OUTCOME & MEASURES: Rate of change in estimated creatinine clearance, change in proteinuria, and new-onset hypertension.
245 patients were enrolled. Of these, 223 women (136 and 87 in the pregnancy and nonpregnancy groups, respectively) had serum creatinine levels<or=1.2 mg/dL at diagnosis. Baseline data (including age, estimated creatinine clearance, prevalence of hypertension, and histologic grade of kidney damage) were similar between groups with the exception of proteinuria (protein excretion, 1.33 vs 0.95 g/d in the pregnancy vs nonpregnancy groups, respectively; P=0.03). Kidney function decreased 1.31 mL/min/y (95% CI, 0.99-1.63) during a median follow-up of 10 years (range, 5-31 years) and did not differ between groups. Baseline proteinuria predicted a faster decrease, but did not modify the effect of pregnancy. Pregnancy did not affect changes in proteinuria over time or risk of new-onset hypertension.
Unrecognized or unmeasured factors associated with the decision of becoming pregnant might have influenced results.
Pregnancy does not seem to affect the long-term outcome of kidney disease in women with IgA nephropathy and preserved kidney function.
目前尚不清楚妊娠是否会影响 IgA 肾病的长期预后。本研究旨在比较具有生育能力的女性 IgA 肾病患者中肾功能正常且怀孕和未怀孕患者的肾脏疾病长期结局。
多中心纵向队列研究。
本研究入选了 35 个肾病中心参加的由意大利肾脏病学会发起的妊娠与肾脏病全国协作研究组的具有经肾活检证实的 IgA 肾病、诊断时血清肌酐水平≤1.2mg/dL 和至少 5 年随访的育龄期妇女。预测因素：妊娠，作为一个时间依赖变量；基线蛋白尿；高血压；以及肾脏活检的组织学特征。
估算的肌酐清除率的变化率、蛋白尿的变化和新发生的高血压。
共纳入 245 例患者，其中 223 例（妊娠组 136 例，非妊娠组 87 例）诊断时血清肌酐水平≤1.2mg/dL。两组间除蛋白尿外（妊娠组和非妊娠组蛋白尿排泄分别为 1.33g/d 和 0.95g/d；P=0.03），基线数据（包括年龄、估算的肌酐清除率、高血压患病率和肾脏损害的组织学分级）相似。中位随访 10 年（范围 5-31 年）期间，肾功能每年下降 1.31mL/min/y（95%可信区间，0.99-1.63），两组间无差异。基线蛋白尿预测肾功能下降较快，但不能改变妊娠的影响。妊娠并不影响蛋白尿随时间的变化或新发高血压的风险。
可能影响怀孕决策的未识别或未测量因素会影响结果。
妊娠似乎不会影响 IgA 肾病和肾功能正常的女性的肾脏疾病的长期结局。
