Department of Medicine, Kidney Center, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Clin Exp Nephrol. 2019 Jun;23(6):852-858. doi: 10.1007/s10157-019-01716-7. Epub 2019 Mar 11.
Recently, a new classification has been established for membranoproliferative glomerulonephritis (MPGN). However, the effect of the new classification on MPGN treatment is not fully understood.
We conducted a retrospective study of 87 patients with biopsies diagnosed as MPGN. We reclassified 87 MPGN patients diagnosed between 1977 and 2014 at our hospital, according to the new classification, and analyzed both primary immune complex (IC)- and Alternative pathway (AP)-mediated MPGN [corrected] in terms of clinicopathological features, treatment, and renal prognosis.
Proteinuria was abundant in the IC-mediated MPGN group (p = 0.0063), and the serum albumin level was significantly lower in the IC-mediated MPGN group (p = 0.0186). The serum C3 value was significantly lower in the CP-mediated MPGN group (p = 0.0317). Serum CH50 values were also lower in the CP-mediated MPGN group (p = 0.0404). However, glomerular deposition of C3 showed no significant differences in immunofluorescence findings. The 148.6-month renal survival rate was similar in both groups (p = 0.445).
These results suggested no significant differences in complement activation of the solid phase in local glomeruli and therefore equivalent in renal prognosis [corrected].
最近,膜增生性肾小球肾炎(MPGN)建立了新的分类。然而,新分类对 MPGN 治疗的影响尚不完全清楚。
我们对 87 例经活检诊断为 MPGN 的患者进行了回顾性研究。我们根据新的分类重新分类了 87 例在我院诊断为 MPGN 的患者,分析了原发性免疫复合物(IC)和替代途径(AP)介导的 MPGN 在临床病理特征、治疗和肾脏预后方面的差异。
IC 介导的 MPGN 组蛋白尿丰富(p=0.0063),血清白蛋白水平显著降低(p=0.0186)。CP 介导的 MPGN 组血清 C3 值显著降低(p=0.0317)。CP 介导的 MPGN 组血清 CH50 值也较低(p=0.0404)。然而,免疫荧光检查显示肾小球内 C3 沉积无明显差异。两组 148.6 个月的肾脏存活率相似(p=0.445)。
这些结果表明局部肾小球固相补体激活无明显差异,因此肾脏预后相当。