Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China.
Nephrol Dial Transplant. 2011 Apr;26(4):1247-52. doi: 10.1093/ndt/gfq553. Epub 2010 Sep 8.
Massive proteinuria is often associated with hypoalbuminaemia in glomerulopathy. However, patients may have normal levels of serum albumin despite heavy proteinuria in many circumstances. This study analysed factors affecting serum levels of albumin in primary glomerulopathy patients with nephrotic-range proteinuria.
The renal histopathological data of 780 consecutive adult patients (age ≥ 18 years old) with primary glomerulopathy and nephrotic-range proteinuria, who received native renal biopsies in Peking University First Hospital from 1998 to 2007, were retrospectively analysed.
Compared with patients with hypoalbuminaemia (serum albumin < 30 g/L), patients without hypoalbuminaemia were significantly younger (P < 0.001) and had significantly lower levels of proteinuria (P < 0.001). Patients without hypoalbuminaemia had a significantly higher proportion of IgA nephropathy (66.0% vs. 17.2%, P < 0.001). The independent predictors of hypoalbuminaemia in nephrotic-range proteinuria patients included age, gender, interval between onset of the disease and renal biopsy, proteinuria level, and pathological type of glomerulopathy. A serum level of albumin ≥ 35 g/L could predict IgA nephropathy with a specificity of 95.8%, and specificity increased with age.
Among patients with primary glomerulopathy and nephrotic-range proteinuria, normoalbuminaemia is associated with IgA nephropathy.
大量蛋白尿常伴有肾小球病中的低白蛋白血症。然而，在许多情况下，尽管有大量蛋白尿，患者的血清白蛋白水平可能正常。本研究分析了原发性肾小球病肾病范围蛋白尿患者影响血清白蛋白水平的因素。
回顾性分析了 1998 年至 2007 年北京大学第一医院接受肾活检的 780 例连续成年原发性肾小球病肾病范围蛋白尿患者的肾组织病理数据，这些患者年龄均≥18 岁。
与低白蛋白血症患者（血清白蛋白<30g/L）相比，无低白蛋白血症患者明显更年轻（P<0.001），蛋白尿水平明显更低（P<0.001）。无低白蛋白血症患者中 IgA 肾病的比例明显更高（66.0%比 17.2%，P<0.001）。肾病范围蛋白尿患者发生低白蛋白血症的独立预测因素包括年龄、性别、疾病发病至肾活检的时间间隔、蛋白尿水平和肾小球病的病理类型。血清白蛋白水平≥35g/L 可预测 IgA 肾病，特异性为 95.8%，特异性随年龄增加而增加。
在原发性肾小球病肾病范围蛋白尿患者中，正常白蛋白血症与 IgA 肾病相关。
