Nephrology, Dialysis, and Renal Transplantation Department, University North Hospital, 42055 Saint-Étienne Cedex 2, France.
J Am Soc Nephrol. 2011 Apr;22(4):752-61. doi: 10.1681/ASN.2010040355. Epub 2011 Jan 21.
For the individual patient with primary IgA nephropathy (IgAN), it remains a challenge to predict long-term outcomes for patients receiving standard treatment. We studied a prospective cohort of 332 patients with biopsy-proven IgAN patients followed over an average of 13 years. We calculated an absolute renal risk (ARR) of dialysis or death by counting the number of risk factors present at diagnosis: hypertension, proteinuria ≥1 g/d, and severe pathologic lesions (global optical score, ≥8). Overall, the ARR score allowed significant risk stratification (P < 0.0001). The cumulative incidence of death or dialysis at 10 and 20 years was 2 and 4%, respectively, for ARR=0; 2 and 9% for ARR=1; 7 and 18% for ARR=2; and 29 and 64% for ARR=3, in adequately treated patients. When achieved, control of hypertension and reduction of proteinuria reduced the risk for death or dialysis. In conclusion, the absolute renal risk score, determined at diagnosis, associates with risk for dialysis or death.
对于接受标准治疗的原发性 IgA 肾病 (IgAN) 患者个体，预测其长期预后仍然是一个挑战。我们研究了一组前瞻性队列的 332 名活检证实的 IgAN 患者，平均随访 13 年。我们通过计算诊断时存在的风险因素（高血压、蛋白尿≥1g/d 和严重的病理损伤（全球光学评分，≥8））的数量来计算绝对肾脏风险 (ARR)。总体而言，ARR 评分可显著进行风险分层 (P<0.0001)。在充分治疗的患者中，ARR=0 的患者在 10 年和 20 年时的死亡或透析累积发生率分别为 2%和 4%；ARR=1 的患者分别为 2%和 9%；ARR=2 的患者分别为 7%和 18%；ARR=3 的患者分别为 29%和 64%。当实现时，控制高血压和减少蛋白尿可降低死亡或透析的风险。总之，诊断时确定的绝对肾脏风险评分与透析或死亡风险相关。
