IgA 肾病患者的妊娠与肾脏结局：一项队列研究。

Pregnancy and Kidney Outcomes in Patients With IgA Nephropathy: A Cohort Study.

机构信息

Renal Division, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China; Renal Division, Shanxi Medical University Second Hospital, Shanxi Kidney Disease Institute, Taiyuan, China.

出版信息

Am J Kidney Dis. 2017 Aug;70(2):262-269. doi: 10.1053/j.ajkd.2017.01.043. Epub 2017 Mar 18.

DOI:10.1053/j.ajkd.2017.01.043

PMID:28320554

Abstract

BACKGROUND

The outcomes of pregnancy in immunoglobulin A nephropathy (IgAN) are controversial. This cohort study assessed the effects of pregnancy on kidney disease progression and risk factors for adverse pregnancy outcomes in patients with IgAN.

STUDY DESIGN

A cohort study.

SETTING & PARTICIPANTS: Women of child-bearing age with IgAN and minimum follow-up of 1 year after biopsy from December 2003 to September 2014.

PREDICTORS

Pregnancy, treated as a time-dependent variable; baseline (at time of biopsy) estimated glomerular filtration rate (eGFR), proteinuria, blood pressure, and kidney pathology (Oxford MEST classification).

OUTCOMES

Kidney disease progression event, defined as 30% decline in eGFR or end-stage kidney disease; rate of eGFR decline; and adverse pregnancy outcomes, including severe preeclampsia and fetal loss.

RESULTS

Of 413 patients enrolled, 266 (64.4%), 101 (24.5%), 40 (9.6%), and 6 (1.5%) had chronic kidney disease (CKD) stages 1, 2, 3, and 4, respectively. During follow-up, 104 had 116 pregnancies, of which 110 continued beyond week 20; 309 patients did not become pregnant. After adjustment for age, eGFR, mean arterial pressure, proteinuria, and pathology class at the time of biopsy, subsequent pregnancy among patients with CKD stages 3 to 4, but not CKD stages 1 to 2, was associated with faster eGFR decline (-7.44 vs -3.90mL/min/1.73m per year; P=0.007) and increased incidence of kidney progression events (HR, 5.14; 95% CI, 1.16-22.74) compared with patients who did not become pregnant.

LIMITATIONS

Relatively small sample size and single-center experience.

CONCLUSIONS

Pregnancy accelerated kidney disease progression in women with IgAN and CKD stage 3, but not in those at stage 1 or 2.

摘要

背景

免疫球蛋白 A 肾病（IgAN）患者妊娠的结局存在争议。本队列研究评估了妊娠对 IgAN 患者肾脏疾病进展的影响，以及对不良妊娠结局的影响。

研究设计

队列研究。

研究场所和参与者

2003 年 12 月至 2014 年 9 月，年龄在生育期的 IgAN 患者，活检后至少随访 1 年。

预测因素

妊娠，作为一个时间相关的变量；基线（活检时）估计肾小球滤过率（eGFR）、蛋白尿、血压和肾脏病理（牛津 MEST 分类）。

结局

肾脏疾病进展事件，定义为 eGFR 下降 30%或终末期肾病；eGFR 下降率；以及不良妊娠结局，包括重度子痫前期和胎儿丢失。

结果

在纳入的 413 例患者中，分别有 266（64.4%）、101（24.5%）、40（9.6%）和 6（1.5%）例患者的慢性肾脏病（CKD）分期为 1、2、3 和 4 期。在随访期间，104 例患者发生了 116 次妊娠，其中 110 次妊娠持续超过 20 周；309 例患者未怀孕。在校正了活检时的年龄、eGFR、平均动脉压、蛋白尿和病理分级后，CKD 3 至 4 期的患者发生后续妊娠与 eGFR 下降更快（-7.44 与-3.90ml/min/1.73m 每年；P=0.007）和肾脏进展事件的发生率增加（HR，5.14；95%CI，1.16-22.74）有关，而未妊娠的患者则没有这种关系。