Yonekura Yuriko, Goto Shunsuke, Sugiyama Hitoshi, Kitamura Hiroshi, Yokoyama Hitoshi, Nishi Shinichi
Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata, Okayama, 700-8558, Japan.
Clin Exp Nephrol. 2015 Jun;19(3):359-70. doi: 10.1007/s10157-014-0993-y. Epub 2014 Jun 11.
This study aimed to describe the influences of larger physical constitutions including obesity on the amount of urine protein excretion (AUPE) in primary glomerulonephritis. The distinct effects on the AUPE in various types of glomerulonephritis were evaluated.
Using the database of the Japan Renal Biopsy Registry (J-RBR) from 2007 to 2010, 4060 cases with primary glomerulonephritis including MCNS, FSGS, MN, MPGN, IgAN, and non-IgA were reviewed. The AUPEs were compared between high and low Body Mass Index (BMI) groups, and larger and smaller body surface area (BSA) groups using the indexes of BMI 25.0 kg/m(2) and BSA 1.73 m(2) in all cases and in each histological group. Multivariable analysis was performed to evaluate the predominant contributors to the AUPE.
The larger physical constitution groups (BMI ≥25.0 kg/m(2) or BSA ≥1.73 m(2)) had significantly higher AUPEs in all cases with primary glomerulonephritis. When compared in each histological group, the mean AUPEs were significantly higher in the larger physical constitution groups, excluding the FSGS and non-IgA groups. Multiple regression analysis revealed that the significant contributors to the AUPE were BMI and BSA in MCNS and MN, whereas BMI and BSA were not significant and mean blood pressure and serum creatinine were significant in FSGS and non-IgA.
Larger physical constitutions including obesity had a significant impact on the increase in the AUPE in primary glomerulonephritis, especially in MCNS and MN. However, FSGS and non-IgA were distinct for having blood pressure and renal dysfunction as possibly the major causes of proteinuria.
本研究旨在描述包括肥胖在内的较大体型对原发性肾小球肾炎患者尿蛋白排泄量（AUPE）的影响。评估了不同类型肾小球肾炎对AUPE的不同影响。
使用日本肾活检登记处（J-RBR）2007年至2010年的数据库，回顾了4060例原发性肾小球肾炎患者，包括微小病变性肾病（MCNS）、局灶节段性肾小球硬化（FSGS）、膜性肾病（MN）、膜增生性肾小球肾炎（MPGN）、IgA肾病（IgAN）和非IgA肾病。在所有病例以及每个组织学组中，使用体重指数（BMI）25.0 kg/m²和体表面积（BSA）1.73 m²的指标，比较高BMI组和低BMI组以及大BSA组和小BSA组之间的AUPE。进行多变量分析以评估AUPE的主要影响因素。
在所有原发性肾小球肾炎病例中，体型较大的组（BMI≥25.0 kg/m²或BSA≥1.73 m²）的AUPE显著更高。在每个组织学组中进行比较时，除FSGS组和非IgA肾病组外，体型较大的组的平均AUPE显著更高。多元回归分析显示，MCNS和MN中AUPE的显著影响因素是BMI和BSA，而在FSGS和非IgA肾病中，BMI和BSA不显著，平均血压和血清肌酐显著。
包括肥胖在内的较大体型对原发性肾小球肾炎患者AUPE的增加有显著影响，尤其是在MCNS和MN中。然而，FSGS和非IgA肾病不同，血压和肾功能不全可能是蛋白尿的主要原因。
