Department of Nephrology, 1st Medical Faculty, Charles University, Prague, Czech Republic.
Nephrol Dial Transplant. 2012 Apr;27(4):1492-8. doi: 10.1093/ndt/gfr482. Epub 2011 Sep 2.
The aim of our study was to retrospectively analyse the clinical data and the histological findings of 343 patients (pts) followed up with IgA nephropathy (IgAN) in our department of nephrology. We have assessed the main demographic, clinical and histological data, and the medical treatment of IgAN pts.
Multivariate analysis was used to evaluate the effect of different variables on ≥50% increase of plasma creatinine level from baseline during a median follow-up of 4 years.
In our group of IgAN pts, the male gender (68%) predominated over female gender (32%). At the time of renal biopsy, the median age of IgAN pts was 32.3 (18-90) years, the median level of serum creatinine was 119 μmol/L and the median level of proteinuria was 1.8 g/day. Most of the pts were found to have arterial hypertension (56.7%). The majority of the pts with arterial hypertension were treated with inhibitors of angiotensin-converting enzyme (80.4%) and the remaining pts (42.6%) were treated with angiotensin II receptor blockers. Fifty per cent of the pts (170 pts) were treated of corticosteroids, 21% of the pts (71 pts) used a combined immunosuppressive treatment of corticosteroids and cyclophosphamide, 8% of the pts (27 pts) took azathioprine, 1.5% of the pts (5 pts) took cyclosporine and 1.5% of the pts (5 pts) were given mycophenolate mofetil. Hypertension at presentation, fibrointimal proliferation of arterial vessels, interstitial fibrosis and interstitial inflammation were shown to be associated with ≥50% increase of plasma creatinine level from baseline in univariate analysis (P<0.05 for hypertension and fibrointimal proliferation; P<0.01 for interstitial fibrosis and inflammation). Using stepwise logistic regression presenting proteinuria>2 g/day [odds ratio (OR)=2.24, P<0.01], tubular atrophy (OR=4.97, P<0.01) and damage of tubular epithelium (OR=1.78, P<0.05) were found as risk factors for ≥50% increase of plasma creatinine level from baseline.
Our retrospective analysis found valuable information not only about the clinical, laboratory and histological findings in IgAN pts but also information about the risk factors influencing the progression of renal insufficiency.
本研究旨在回顾性分析我院肾病科随访的 343 例 IgA 肾病（IgAN）患者的临床资料和组织学检查结果。我们评估了主要的人口统计学、临床和组织学数据以及 IgAN 患者的治疗情况。
采用多变量分析评估不同变量对中位随访 4 年期间血浆肌酐水平从基线升高≥50%的影响。
在我们的 IgAN 患者组中，男性（68%）多于女性（32%）。在进行肾活检时，IgAN 患者的中位年龄为 32.3（18-90）岁，中位血清肌酐水平为 119 μmol/L，中位蛋白尿水平为 1.8 g/天。大多数患者存在高血压（56.7%）。大多数高血压患者接受血管紧张素转换酶抑制剂（80.4%）治疗，其余患者（42.6%）接受血管紧张素 II 受体阻滞剂治疗。50%的患者（170 例）接受皮质类固醇治疗，21%的患者（71 例）接受皮质类固醇和环磷酰胺联合免疫抑制治疗，8%的患者（27 例）接受硫唑嘌呤治疗，1.5%的患者（5 例）接受环孢素治疗，1.5%的患者（5 例）接受霉酚酸酯治疗。单变量分析显示，起病时高血压、动脉血管内膜纤维化增生、间质纤维化和间质炎症与血浆肌酐水平从基线升高≥50%相关（高血压和内膜纤维化增生 P<0.05；间质纤维化和炎症 P<0.01）。采用逐步逻辑回归分析发现，蛋白尿>2 g/天[比值比（OR）=2.24，P<0.01]、肾小管萎缩（OR=4.97，P<0.01）和肾小管上皮损伤（OR=1.78，P<0.05）是血浆肌酐水平从基线升高≥50%的危险因素。
本回顾性分析不仅提供了有关 IgAN 患者临床、实验室和组织学表现的有价值信息，还提供了影响肾功能不全进展的危险因素信息。
