Department of Nephrology, Juntendo University Faculty of Medicine, Hongo 2-1-1, Bunkyo-Ku, Tokyo, 113-8421, Japan.
Progressive Renal Diseases Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan, Tokyo, Japan.
Clin Exp Nephrol. 2021 Sep;25(9):988-995. doi: 10.1007/s10157-021-02069-w. Epub 2021 May 11.
Novel criteria for the remission of Immunoglobulin A nephropathy (IgAN) based on an opinion survey of Japanese nephrologists and literature review were proposed in 2013. This single-center, longitudinal retrospective cohort study was conducted to validate this criteria.
Present study included the IgAN patients diagnosed between 2001 and 2005 in the Juntendo University Hospital. Remission of hematuria was defined as three consecutive dipstick test results of ( -) to ( ±) or a red blood cell count < 5 in urinary sediment per high-power field during at least 6 months. Remission of proteinuria was defined as three consecutive dipstick results of ( -) to ( ±) during at least 6 months. We categorized four groups according to the remission status which was assessed 2 years after the renal biopsy. The primary outcome was a 50% increase in the serum creatinine over the baseline. We evaluated the slope of eGFR decline (mL/min/1.73 m/year) and a decrease in the eGFR of 30% from baseline eGFR as the secondary outcome, respectively.
A total of 74 patients (male: 47.3%, median age: 30 years) were included and were followed for a median of 86.5 months. During the period, forty-one patients achieved neither remission of proteinuria nor hematuria (NR). Twelve patients met the primary study outcome. A survival analysis revealed that the NR had the worst prognosis and the steepest slope of eGFR decline.
Although further validation in a large cohort is necessary, these novel remission criteria for IgAN patients appear to predict the renal prognosis.
2013 年，日本肾病学家通过意见调查和文献回顾提出了用于 IgA 肾病（IgAN）缓解的新标准。本单中心、纵向回顾性队列研究旨在验证该标准。
本研究纳入了 2001 年至 2005 年期间在顺天堂大学医院诊断为 IgAN 的患者。血尿缓解定义为至少 6 个月内连续 3 次尿沉渣高倍镜下每视野红细胞计数 < 5，且连续 3 次尿沉渣干化学检查结果为（ -）至（ ±）。蛋白尿缓解定义为至少 6 个月内连续 3 次干化学检查结果为（ -）至（ ±）。我们根据肾活检后 2 年评估的缓解状态将患者分为 4 组。主要结局是血清肌酐较基线升高 50%。我们分别评估了 eGFR 下降斜率（mL/min/1.73 m/年）和 eGFR 从基线 eGFR 下降 30%作为次要结局。
共纳入 74 例患者（男性占 47.3%，中位年龄 30 岁），中位随访时间为 86.5 个月。在此期间，41 例患者既未达到蛋白尿缓解也未达到血尿缓解（NR）。12 例患者达到了主要研究终点。生存分析显示，NR 患者的预后最差，eGFR 下降斜率最陡。
尽管需要在更大的队列中进一步验证，但这些新的 IgAN 患者缓解标准似乎可以预测肾脏预后。
