Bagchi Soumita, Singh Geetika, Yadav Rajni, Kalaivani Mani, Mahajan Sandeep, Bhowmik Dipankar, Dinda Amit, Agarwal Sanjay Kumar
a Department of Nephrology , All India Institute of Medical Sciences , New Delhi , India ;
b Department of Pathology , All India Institute of Medical Sciences , New Delhi , India ;
Ren Fail. 2016;38(3):431-6. doi: 10.3109/0886022X.2016.1138817. Epub 2016 Feb 2.
IgA nephropathy (IgAN) is known to have an aggressive course in Asians. There is a paucity of data regarding the Oxford classification pattern of Indian patients with IgAN. This study aims to characterize the clinical and histopathologic profile of these patients.
All patients diagnosed to have primary IgAN by kidney biopsy in the nephrology department from July 2009 to July 2014 were included in this study. All kidney biopsies were reviewed and the MEST score was assigned as per the Oxford classification. The clinical features and Oxford classification score of patients were characterized.
Nephrotic range proteinuria (NRP) (65/103, 63.1%) with or without edema was the commonest presentation. 67.0% patients had eGFR ≥ 60 mL/min and 16.5% patients had eGFR < 30 mL/min. Of the 103 patients, 80 (77.7%) had M1, 10 (9.7%) had E1, 45 (43.7%) had S1 and 41 (39.8%) had T1/T2 lesions by the Oxford criteria and 11 (10.7%) patients had crescents. 62 patients had eGFR ≥ 30 mL/min and follow up for at least 6 months (median -17.7 (6-65.1) months) of whom 52(83.9%) had received ACEi/ARBs and 38 (61.3%) had received immunosuppression. 11/62 (17.7%) patients developed renal worsening in this period of which 7 (11.3%) developed end stage kidney disease (ESKD).
Indian patients with primary IgA nephropathy have a unique profile. They commonly present with nephrotic range proteinuria. A significant proportion of these patients have normal renal function despite heavy proteinuria. Mesangial proliferative lesions are predominant with a paucity of endocapillary proliferation and crescents compared to other Asian populations. Immunosuppressive use is more common in Indian patients.
已知IgA肾病（IgAN）在亚洲人中有侵袭性病程。关于印度IgAN患者的牛津分类模式的数据很少。本研究旨在描述这些患者的临床和组织病理学特征。
纳入2009年7月至2014年7月在肾内科经肾活检诊断为原发性IgA肾病的所有患者。回顾所有肾活检，并根据牛津分类指定MEST评分。对患者的临床特征和牛津分类评分进行了描述。
肾病范围蛋白尿（NRP）（65/103，63.1%）伴或不伴水肿是最常见的表现。67.0%的患者估算肾小球滤过率（eGFR）≥60 mL/（min·1.73m²），16.5%的患者eGFR<30 mL/（min·1.73m²）。根据牛津标准，103例患者中，80例（77.7%）有M1病变，10例（9.7%）有E1病变，45例（43.7%）有S1病变，41例（39.8%）有T1/T2病变，11例（10.7%）患者有新月体形成。62例患者eGFR≥30 mL/（min·1.73m²）且随访至少6个月（中位时间-17.7（6-65.1）个月），其中52例（83.9%）接受了血管紧张素转换酶抑制剂（ACEi）/血管紧张素Ⅱ受体阻滞剂（ARBs）治疗，38例（61.3%）接受了免疫抑制治疗。在此期间，11/62（17.7%）的患者出现肾功能恶化，其中7例（11.3%）发展为终末期肾病（ESKD）。
印度原发性IgA肾病患者有独特的特征。他们通常表现为肾病范围蛋白尿。这些患者中有很大一部分尽管蛋白尿严重但肾功能正常。与其他亚洲人群相比，系膜增生性病变占主导，毛细血管内增生和新月体形成较少。免疫抑制治疗在印度患者中更常见。
