D'Amico G
Division of Nephrology, San Carlo Hospital, Milan, Italy.
Am J Kidney Dis. 1988 Nov;12(5):353-7. doi: 10.1016/s0272-6386(88)80023-4.
Two different clinical syndromes might be observed at presentation in most patients with IgA nephropathy (IgAN): (1) an acute reversible episode of macroscopic hematuria or (2) asymptomatic urinary abnormalities. Patients in these groups differ by genetic markers, the severity of their histologic lesions, and the rate of progression to renal insufficiency. Macroscopic hematuria is more common in children, and its frequency decreases with increasing age. In our experience, most patients presenting in adulthood with macroscopic hematuria did not have proteinuria or microscopic hematuria prior to the episode of macroscopic hematuria, suggesting the onset of disease was indeed in adulthood. IgAN is not a benign disease. About 20% of patients reach end-stage renal failure after 20 years of clinical disease. Features generally associated with a poor prognosis include older age at onset, no history of recurrent macroscopic hematuria, hypertension, and consistent proteinuria. In some studies, men progressed more rapidly than women. Using the regression of Cox in the present study, the magnitude of proteinuria was the only clinical parameter that independently predicted progressive renal impairment.
大多数IgA肾病（IgAN）患者在就诊时可能会出现两种不同的临床综合征：（1）肉眼血尿的急性可逆发作，或（2）无症状性尿液异常。这些组中的患者在基因标记、组织学病变的严重程度以及进展至肾功能不全的速率方面存在差异。肉眼血尿在儿童中更为常见，其发生率随年龄增长而降低。根据我们的经验，大多数成年期出现肉眼血尿的患者在肉眼血尿发作之前没有蛋白尿或镜下血尿，这表明疾病确实在成年期发病。IgAN并非良性疾病。约20%的患者在临床疾病发生20年后会发展至终末期肾衰竭。通常与预后不良相关的特征包括发病年龄较大、无反复肉眼血尿病史、高血压和持续性蛋白尿。在一些研究中，男性的病情进展比女性更快。在本研究中使用Cox回归分析，蛋白尿的程度是唯一独立预测进行性肾功能损害的临床参数。
