Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, 956 Court Ave., Suite A220, Memphis, TN, 38163, USA.
Kidney Disease Center, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan.
Clin Exp Nephrol. 2022 Apr;26(4):325-332. doi: 10.1007/s10157-021-02161-1. Epub 2021 Nov 23.
Patients with nephrosclerosis display heterogenous clinical phenotypes, often leading to a clinical diagnosis discordant with pathological nephrosclerosis diagnosis. However, little is known about clinical factors associated with clinicopathological discordance of biopsy-proven nephrosclerosis.
In a cross-sectional study of 891 patients with biopsy-proven nephrosclerosis registered in the Japan Renal Biopsy Registry (J-RBR) between July 2007 and June 2016, we examined clinical characteristics associated with a pre-biopsy clinical diagnosis discordant with pathological nephrosclerosis diagnosis using multivariable logistic regression with adjustment for relevant clinical characteristics.
Overall, the mean (SD) age was 58.6 (13.7) years; 67.6% of patients were male; and 63.2% were on antihypertensive drugs. The median estimated glomerular filtration rate (eGFR) was 43.8 mL/min/1.73 m and the median proteinuria was 0.5 g/day. Of the 891 patients, 497 (55.8%) had a clinical diagnosis discordant with pathological nephrosclerosis diagnosis, with chronic nephritic syndrome being the most common (> 75%) discordant clinical diagnosis. After multivariable adjustment, age (odds ratio 1.34, [95% confidence interval, 1.16-1.55], per 10 years increase), eGFR (1.10 [1.00-1.21], per 10 mL/min/1.73 m increase), and proteinuria (1.20 [1.03-2.16], per 1 g/day decrease) were found to be significantly associated with the clinicopathological discordance.
Patients with older age, higher eGFR, and lower proteinuria had significantly higher likelihood of being clinically diagnosed with other glomerular disease in patients with biopsy-proven nephrosclerosis. Our findings highlight the heterogeneous clinical phenotypes of nephrosclerosis and suggest the need for continuous improvement of clinical diagnostic accuracy as well as for wider kidney biopsy indications for nephrosclerosis.
患有肾硬化症的患者表现出不同的临床表型，这通常导致临床诊断与病理肾硬化症诊断不一致。然而，对于与活检证实的肾硬化症的临床病理不一致相关的临床因素知之甚少。
在 2007 年 7 月至 2016 年 6 月期间在日本肾活检登记处（J-RBR）登记的 891 例活检证实的肾硬化症患者的横断面研究中，我们使用多变量逻辑回归检查了与病理肾硬化症诊断不一致的临床诊断相关的临床特征，并调整了相关的临床特征。
总体而言，患者的平均（标准差）年龄为 58.6（13.7）岁；67.6%的患者为男性；63.2%的患者正在服用抗高血压药物。中位估计肾小球滤过率（eGFR）为 43.8ml/min/1.73m，中位蛋白尿为 0.5g/天。在 891 例患者中，有 497 例（55.8%）的临床诊断与病理肾硬化症诊断不一致，慢性肾炎综合征是最常见的（>75%）不一致的临床诊断。经过多变量调整，年龄（优势比 1.34 [95%置信区间，1.16-1.55]，每增加 10 岁）、eGFR（1.10 [1.00-1.21]，每增加 10ml/min/1.73m）和蛋白尿（1.20 [1.03-2.16]，每减少 1g/天）与临床病理不一致显著相关。
在活检证实的肾硬化症患者中，年龄较大、eGFR 较高和蛋白尿较低的患者，临床诊断为其他肾小球疾病的可能性显著更高。我们的研究结果突出了肾硬化症的异质性临床表型，并表明需要不断提高临床诊断准确性，以及扩大肾硬化症的肾活检适应证。
