Suzuki Yusuke, Matsuzaki Keiichi, Suzuki Hitoshi, Sakamoto Naoko, Joh Kensuke, Kawamura Tetsuya, Tomino Yasuhiko, Matsuo Seiichi
Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Juntendo University, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan,
Clin Exp Nephrol. 2014 Jun;18(3):481-6. doi: 10.1007/s10157-013-0849-x. Epub 2013 Aug 4.
The remission criteria of immunoglobulin A (IgA) nephropathy have varied depending on the clinical study. Therefore, nephrologists cannot make a uniform assessment of treatment outcomes and the standardization of explanations of the condition is difficult in patients with IgA nephropathy. This study aims to propose clinical remission criteria for IgA nephropathy based on a nationwide opinion survey in Japan regarding IgA nephropathy remission/relapse.
This nationwide survey was sent to 312 teaching facilities of the Japanese Society of Nephrology by Progressive Renal Disease Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan.
Valid answers were obtained from 193 facilities (61.9 %) (136 internal medicine facilities and 57 pediatric facilities), of which 134 (69.4 %) thought that both hematuria and proteinuria should be used in the remission standards. Approximately half of the survey respondents shared the opinion on standards of negative results for hematuria and proteinuria and the duration and frequency of these conditions.
In this paper, we propose a standardized set of criteria for defining IgA nephropathy remission: three consecutive negative results over a 6-month period in urinary occult blood tests; urinary sediment red blood cell count of <5/high-power field (hematuria remission); and urinary protein of <0.3 g/day (g/g Cr; proteinuria remission). Clinical remission is defined as cases with both hematuria and proteinuria remission. These consensus-based remission criteria should be verified in future studies. In the meantime, they may be useful in predicting therapeutic outcome in cases of IgA nephropathy.
免疫球蛋白A（IgA）肾病的缓解标准因临床研究而异。因此，肾病学家无法对治疗结果进行统一评估，且对IgA肾病患者病情解释的标准化也很困难。本研究旨在基于日本全国范围内关于IgA肾病缓解/复发的意见调查，提出IgA肾病的临床缓解标准。
日本厚生劳动省的进行性肾病研究、难治性疾病研究将这项全国性调查发送给了日本肾脏病学会的312个教学机构。
从193个机构（61.9%）（136个内科机构和57个儿科机构）获得了有效答案，其中134个（69.4%）认为缓解标准应同时使用血尿和蛋白尿指标。大约一半的调查受访者对血尿和蛋白尿阴性结果的标准以及这些情况的持续时间和频率有相同看法。
在本文中，我们提出了一套标准化的IgA肾病缓解定义标准：尿潜血试验连续6个月呈阴性结果；尿沉渣红细胞计数<5/高倍视野（血尿缓解）；尿蛋白<0.3g/天（g/g肌酐；蛋白尿缓解）。临床缓解定义为血尿和蛋白尿均缓解病例。这些基于共识的缓解标准应在未来研究中得到验证。同时，它们可能有助于预测IgA肾病病例的治疗结果。
