Deng Wei, Tan Xiaojun, Zhou Qian, Ai Zhen, Liu Wenting, Chen Wei, Yu Xueqing, Yang Qiongqiong
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, Guangdong, 510080, China.
Department of Nephrology, Kaiping Central Hospital, Jiangmen, 529300, China.
BMC Nephrol. 2018 Feb 7;19(1):31. doi: 10.1186/s12882-018-0829-1.
The prognostic effect of gender on immunoglobulin A nephropathy (IgAN) is not clear. We explored gender-related differences in clinicopathological features and renal outcomes in IgAN.
This was a single-centre retrospective study. Patients were divided into two groups according to gender. The clinicopathological features at biopsy and renal outcomes during the follow-up were collected and analysed. Renal outcomes were defined as the doubling of baseline serum creatinine and end-stage renal disease (ESRD) (estimated glomerular filtration rate < 15 mL/min/1.73 m, dialysis, or renal transplantation). The prognostic effects of gender were evaluated by Cox regression models.
A total of 988 eligible IgAN patients were enrolled, and the ratio of males to females was 1:1.4. Compared with female patients, male patients had worse renal function, greater proteinuria, a higher prevalence of hypertension, hypertriglyceridaemia and hyperuricaemia, and more severe segmental sclerosis and tubular atrophy/interstitial fibrosis. However, haematuria occurred more frequently in female patients. During a median follow-up time of 48.6 (34.7, 62.7) months, no differences in renal survival rates were noted between the male and female groups. Multivariable Cox regression analyses revealed that gender was not a significant risk factor for renal outcomes after frequency matching of baseline eGFR and serum uric acid (SUA) levels. In addition, male and female patients shared similar risk factors, including a low eGFR and increased proteinuria and segmental sclerosis. In males, however, an elevated proportion of global glomerulosclerosis was also a poor prognostic factor for renal survival.
Male IgAN patients presented with worse clinicopathologic features than female patients, but no significant differences were observed in long-term renal survival between male and female patients by eGFR- and SUA level-matching.
性别对免疫球蛋白A肾病（IgAN）的预后影响尚不清楚。我们探讨了IgAN患者临床病理特征和肾脏结局的性别差异。
这是一项单中心回顾性研究。根据性别将患者分为两组。收集并分析活检时的临床病理特征以及随访期间的肾脏结局。肾脏结局定义为基线血清肌酐翻倍和终末期肾病（ESRD）（估计肾小球滤过率<15 mL/min/1.73 m²，透析或肾移植）。通过Cox回归模型评估性别的预后影响。
共纳入988例符合条件的IgAN患者，男女比例为1:1.4。与女性患者相比，男性患者肾功能更差，蛋白尿更多，高血压、高甘油三酯血症和高尿酸血症的患病率更高，节段性硬化和肾小管萎缩/间质纤维化更严重。然而，女性患者血尿更常见。在中位随访时间48.6（34.7，62.7）个月期间，男女组之间的肾脏生存率无差异。多变量Cox回归分析显示，在基线估算肾小球滤过率（eGFR）和血清尿酸（SUA）水平频率匹配后，性别不是肾脏结局的显著危险因素。此外，男性和女性患者具有相似的危险因素，包括低eGFR、蛋白尿增加和节段性硬化。然而，在男性中，全球肾小球硬化比例升高也是肾脏生存的不良预后因素。
男性IgAN患者的临床病理特征比女性患者更差，但通过eGFR和SUA水平匹配，男女患者的长期肾脏生存率无显著差异。
