Riispere Živile, Laurinavičius Arvydas, Kuudeberg Anne, Seppet Elviira, Sepp Kristin, Ilmoja Madis, Luman Merike, Kõlvald Külli, Auerbach Asta, Ots-Rosenberg Mai
Institute of Pathological Anatomy and Forensic Medicine, Tartu University, Tartu, Estonia.
Vilnius University and National Centre of Pathology, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.
Medicina (Kaunas). 2016;52(6):340-348. doi: 10.1016/j.medici.2016.11.003. Epub 2016 Nov 22.
Immunoglobulin A nephropathy (IgAN) is the most frequent glomerular disease worldwide and one of the main causes of chronic kidney disease. We aimed to investigate clinicopathological correlations in IgAN patients by gender.
The study was based on a retrospective analysis of renal biopsy data and clinical manifestations of the disease. Consecutive 73 biopsy-proven IgAN cases of male (62%) and female (38%) patients were investigated. Renal biopsies were reviewed using the new Oxford classification assessing the MEST (mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis/adhesion, tubular atrophy/interstitial fibrosis) score. The most powerful IgAN prognostic risk factors, morphological (segmental glomerulosclerosis and tubular atrophy/interstitial fibrosis) as well as clinical (proteinuria and hypertension) were taken into account in the correlation analysis. The mean rate of renal function decline was expressed as a slope of eGFR during the follow-up (FU) dividing delta GFR with the FU years.
The mean age of the patients was 33.7 years (range, 16-76). Follow-up data were available for 64 patients with the mean follow-up of 4.1 years. The mean proteinuria at biopsy was 0.79g/24h. The mean arterial pressure (MAP) was 94.5±16.7mmHg and 7% of the patients were hypertensive. The initial mean estimated glomerular filtration rate (eGFR) was 94.9±30.7mL/min, at the end of the follow-up it was 86.2±27.1mL/min. The mean rate of renal function decline was -3.4±11.9mL/min/1.73m per year in males (P<0.05) and -0.7±5.3mL/min/1.73m per year in females. The Spearman correlation analysis confirmed a higher MEST score in the whole cohort and in males correlated with disease progression. In patients with proteinuria below 1.0g/24h, disease progression was faster in males.
According to the correlation analysis of the main prognostic risk factors, affecting the progression of IgAN, we can conclude that IgA nephropathy in males progresses more rapidly compared to females.
免疫球蛋白A肾病（IgAN）是全球最常见的肾小球疾病，也是慢性肾脏病的主要病因之一。我们旨在按性别调查IgAN患者的临床病理相关性。
本研究基于对肾活检数据和疾病临床表现的回顾性分析。对连续73例经活检证实的IgAN病例进行了研究，其中男性患者占62%，女性患者占38%。使用新的牛津分类法对肾活检进行评估，计算MEST（系膜细胞增生、毛细血管内细胞增生、节段性硬化/粘连、肾小管萎缩/间质纤维化）评分。在相关性分析中考虑了最有力的IgAN预后危险因素，包括形态学因素（节段性肾小球硬化和肾小管萎缩/间质纤维化）以及临床因素（蛋白尿和高血压）。肾功能下降的平均速率用随访期间估算肾小球滤过率（eGFR）的斜率表示，即GFR变化量除以随访年数。
患者的平均年龄为33.7岁（范围16 - 76岁）。64例患者有随访数据，平均随访时间为4.1年。活检时的平均蛋白尿为0.79g/24h。平均动脉压（MAP）为94.5±16.7mmHg，7%的患者患有高血压。初始平均估算肾小球滤过率（eGFR）为94.9±30.7mL/min，随访结束时为86.2±27.1mL/min。男性肾功能下降的平均速率为-3.4±11.9mL/min/1.73m每年（P<0.05），女性为-0.7±5.3mL/min/1.73m每年。Spearman相关性分析证实，在整个队列以及男性中，较高的MEST评分与疾病进展相关。在蛋白尿低于1.0g/24h的患者中，男性疾病进展更快。
根据对影响IgAN进展的主要预后危险因素的相关性分析，我们可以得出结论，男性IgA肾病的进展比女性更快。
