E13 Renal Unit, Groote Schuur Hospital and University of Cape Town, Observatory, 7925 Cape Town, South Africa.
J Natl Med Assoc. 2010 Dec;102(12):1193-7. doi: 10.1016/s0027-9684(15)30774-4.
Glomerular diseases, accompanied by nephrotic syndrome, contribute significantly to end-stage renal disease (ESRD) worldwide. We sought to show the distribution and frequency of biopsy-proven causes of nephrotic syndrome in native black Africans attending the Groote Schuur Hospital in Cape Town, South Africa.
We retrospectively reviewed the biopsy data of 294 black South Africans with biopsy-proven cause of nephrotic syndrome in Cape Town over a 10-year period. Nephrotic proteinuria was accepted as urine protein excretion of at least 3.5 g in 24 hours. Glomerular diseases were classified into primary and secondary types. Serum creatinine concentrations were stratified into 3 levels to reflect the degree of renal dysfunction at the time of presentation. The frequency and distribution of disease were recorded according to age and gender.
Young adults (< or = 40 years of age) constituted 74.1% of the study population. Secondary glomerular diseases were more frequent (58.8%) and human immunodeficiency virus-associated nephropathy (HIVAN) was observed as the leading cause of nephrotic syndrome in both males and females (42.8%). Most patients with HIVAN (73.6%) presented for the first time with severe renal impairment and more than half of patients with non-HIVAN glomerular diseases presented with an abnormal serum creatinine. Of the primary glomerular diseases, mesangiocapillary glomerulonephritis was the commonest cause of the nephrotic syndrome (19.0%), while IgA nephropathy was the least common cause (1.7%).
HIVAN is a major cause of nephrotic syndrome in black South Africans and may be responsible for the rising incidence of ESRD in Africa.
肾小球疾病伴肾病综合征在全球范围内是导致终末期肾病（ESRD）的重要原因。我们旨在展示在南非开普敦的格罗特舒尔医院就诊的本地黑人中经活检证实的肾病综合征的病因分布和频率。
我们对在开普敦的 294 名经活检证实患有肾病综合征的黑人南非人进行了回顾性研究，研究时间为 10 年。肾病性蛋白尿被定义为 24 小时尿液蛋白排泄量至少为 3.5g。肾小球疾病分为原发性和继发性。血清肌酐浓度分为 3 个水平，以反映就诊时肾功能不全的程度。根据年龄和性别记录疾病的频率和分布。
年轻人（≤40 岁）占研究人群的 74.1%。继发性肾小球疾病更为常见（58.8%），人类免疫缺陷病毒相关性肾病（HIVAN）在男性和女性中均为肾病综合征的主要病因（42.8%）。大多数 HIVAN 患者（73.6%）首次就诊时即已出现严重肾功能损害，超过一半的非 HIVAN 肾小球疾病患者就诊时血清肌酐异常。在原发性肾小球疾病中，系膜毛细血管性肾小球肾炎是肾病综合征最常见的病因（19.0%），而 IgA 肾病是最不常见的病因（1.7%）。
HIVAN 是黑人南非人中肾病综合征的一个主要病因，可能是非洲 ESRD 发病率上升的原因。
