Das Uttara, Dakshinamurty Kaligotla Venkata, Prayaga Aruna, Uppin Megha
Department of Nephrology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India.
Saudi J Kidney Dis Transpl. 2015 Sep;26(5):1057-63. doi: 10.4103/1319-2442.164612.
Immunoglobulin A (IgA) nephropathy (IgAN) is the most common biopsy-proven primary glomerular disease in the world and a major contributor to the worldwide burden of endstage renal failure, with a wide geographical variation. To determine the incidence, clinical profile and histological pattern of IgAN in our institute, we reviewed all the patients who had native kidney biopsies with the diagnosis of primary IgAN during the period from 1998 to 2009 in the context of the clinical features. A total of 116 patients with IgAN were finally analyzed; 85 (73%) of the patients were male, the mean age of the patients was 29.2 ± 12.2 (range 10-70) years and the mean duration of disease was 10.4 ± 18.7 months (median: 2 months). Hypertension was present in 74 (63.2%) cases. Gross hematuria was rare. The most common clinical presentation was nephrotic syndrome, followed by chronic renal failure. The mean proteinuria level was 2.5 ± 2.3 g/day (median: 1.7 g/day) and the mean serum creatinine level was 3.04 ± 3.3 mg/dL (median:1.7 mg/dL). The morphological sub-classification (Haas): Class I was the most common (44.4%), followed by class V (23%). IgA co-deposition with C3 and lambda was the most common finding in the immunofluorescence study. The glomerular filtration rate decreased with advanced histological damage. The incidence of IgAN was 7.5%, which is lower as compared with studies from elsewhere. IgAN in our population had a more severe clinical presentation.
免疫球蛋白A(IgA)肾病(IgAN)是世界上经活检证实的最常见的原发性肾小球疾病,也是导致全球终末期肾衰竭负担的主要因素,且存在广泛的地域差异。为了确定我院IgAN的发病率、临床特征和组织学类型,我们结合临床特征回顾了1998年至2009年期间所有经肾活检诊断为原发性IgAN的患者。最终共分析了116例IgAN患者;其中85例(73%)为男性,患者的平均年龄为29.2±12.2岁(范围10 - 70岁),疾病的平均病程为10.4±18.7个月(中位数:2个月)。74例(63.2%)患者存在高血压。肉眼血尿少见。最常见的临床表现是肾病综合征,其次是慢性肾衰竭。平均蛋白尿水平为2.5±2.3g/天(中位数:1.7g/天),平均血清肌酐水平为3.04±3.3mg/dL(中位数:1.7mg/dL)。形态学亚分类(哈斯分类法):I类最常见(44.4%),其次是V类(23%)。免疫荧光研究中最常见的发现是IgA与C3和λ链共沉积。肾小球滤过率随组织学损伤加重而降低。IgAN的发病率为7.5%,与其他地方的研究相比更低。我国人群中的IgAN临床表现更为严重。