抗中性粒细胞胞浆抗体相关肾小球肾炎伴严重肾小球硬化的预后因素：一项基于全国登记处的队列研究
Prognostic Factors in Anti-Neutrophil Cytoplasmic Antibody-Associated Glomerulonephritis with Severe Glomerular Sclerosis: A National Registry-Based Cohort Study.
作者信息
Bjørneklett Rune, Solbakken Vilde, Bostad Leif, Fismen Anne-Siri
机构信息
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway.
出版信息
Patholog Res Int. 2018 Jun 3;2018:5653612. doi: 10.1155/2018/5653612. eCollection 2018.
BACKGROUND
Classification of patients with anti-neutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN) into histological classes is useful for predicting a patient's risk of progression to end-stage renal disease (ESRD). However, even in the worst prognostic group, the 5-year end-stage renal disease-free survival rate is as high as 50%.
OBJECTIVES
To investigate those prognostic factors indicative of progression to ESRD in patients with ANCA-GN and sclerosing histology.
METHODS
Patients from the Norwegian Kidney Biopsy Registry between 1991 and 2012 who had biopsy verified pauci-immune glomerulonephritis, positive ANCA serology, and sclerosing histology were included. Cases with ESRD during follow-up were identified via linkage with the Norwegian Renal Registry. Potential prognostic factors with relevant cut-offs were compared in patients with and without progression to ESRD during follow-up.
RESULTS
Of 23 included patients, 10 progressed to ESRD. ESRD patients had a lower initial estimated glomerular filtration rate (eGFR; 21 versus 52 ml/min/1.73 m) and a lower percentage of normal glomeruli (4% versus 15%). Five-year risks of ESRD with eGFR >15 versus ≤15 ml/min/1.73 m were 77% and 15%, with percentage normal glomeruli >10% versus ≤10%, 83% and 39%.
CONCLUSIONS
eGFR and percentage of normal glomeruli are strong risk factors for ESRD in ANCA-GN with sclerosing histology.
背景
将抗中性粒细胞胞浆抗体相关性肾小球肾炎（ANCA-GN）患者进行组织学分类有助于预测患者进展至终末期肾病（ESRD）的风险。然而，即使在预后最差的组中，5年无终末期肾病生存率仍高达50%。
目的
研究ANCA-GN伴硬化性组织学患者中提示进展至ESRD的预后因素。
方法
纳入1991年至2012年挪威肾脏活检登记处活检证实为寡免疫性肾小球肾炎、ANCA血清学阳性且组织学为硬化性的患者。通过与挪威肾脏登记处的关联确定随访期间发生ESRD的病例。比较随访期间进展至ESRD和未进展至ESRD的患者中具有相关临界值的潜在预后因素。
结果
纳入的23例患者中，10例进展至ESRD。ESRD患者的初始估计肾小球滤过率（eGFR）较低（21对52 ml/min/1.73m²），正常肾小球的百分比也较低（4%对15%）。eGFR>15与≤15 ml/min/1.73m²时ESRD的5年风险分别为77%和15%，正常肾小球百分比>10%与≤10%时，分别为83%和39%。
结论
eGFR和正常肾小球百分比是ANCA-GN伴硬化性组织学患者发生ESRD的强风险因素。
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