Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Department of Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Biomed Res Int. 2022 Jul 7;2022:2177991. doi: 10.1155/2022/2177991. eCollection 2022.
Shrunken pore syndrome (SPS) represents selective impairment of kidney filtration of low-molecular-weight molecules between 1 and 30 kDa and has been related to outcomes including morbidity, mortality, and cardiovascular events. However, the prevalence and kidney outcomes of SPS have not been investigated in patients with IgA nephropathy (IgAN) and membranous nephropathy (MN).
We retrospectively collected information of 536 patients including 414 with IgAN and 122 with MN. SPS was mainly defined by cystatin C-based eGFR < 70% of creatinine-based eGFR using the CAPA-LM equation pairs, while CKD-EPI equations were also employed in sensitivity analyses. Prevalence rate of SPS and its association with end-stage renal disease (ESRD) or severe eGFR decline (≥50% eGFR reduction or doubling of baseline creatinine) were investigated.
44% (8%) patients were identified as possessing SPS using the CAPA-LM definition. ESRD happened in 24 patients during the average follow-up period of 27.7 months. Despite dramatic increase of incidence rate of ESRD for SPS, significant hazard ratio (HR) only existed in IgAN patients after multivariable adjustment (HR: 8.35, 95% CI: 2.10~33.26), but lost significance in sensitivity analyses. 36 patients were determined as having experienced severe eGFR decline after excluding transient creatinine fluctuation. SPS was associated with severe eGFR decline by Kaplan-Meier survival analyses in the overall population as well as the IgAN, MN, male, and female subpopulations, which remained significant in multivariable adjustments in all groups except IgAN. However, only in female patients the association between SPS and eGFR decline remained significant in all the sensitivity analyses.
SPS was independently associated with eGFR decline in female patients with IgAN and MN.
缩小孔综合征（SPS）表现为选择性损害 1 至 30 kDa 低分子量物质的肾脏滤过功能，与发病率、死亡率和心血管事件等结果相关。然而，在 IgA 肾病（IgAN）和膜性肾病（MN）患者中，尚未研究 SPS 的患病率和肾脏结局。
我们回顾性收集了 536 名患者的信息，其中包括 414 名 IgAN 患者和 122 名 MN 患者。SPS 主要通过基于半胱氨酸蛋白酶抑制剂 C 的肾小球滤过率（eGFR）<基于肌酐的 eGFR 的 70%，使用 CAPA-LM 方程对来定义，同时也采用 CKD-EPI 方程进行敏感性分析。研究了 SPS 的患病率及其与终末期肾脏疾病（ESRD）或严重 eGFR 下降（≥50% eGFR 降低或基线肌酐增加一倍）的关系。
使用 CAPA-LM 定义，44%（8%）患者被确定为患有 SPS。在平均 27.7 个月的随访期间，24 名患者发生 ESRD。尽管 SPS 的 ESRD 发生率显著增加，但在多变量调整后，仅在 IgAN 患者中存在显著的危险比（HR）（HR：8.35，95%CI：2.10~33.26），但在敏感性分析中失去意义。排除肌酐波动的一过性升高后，有 36 名患者被确定为经历了严重的 eGFR 下降。Kaplan-Meier 生存分析显示，SPS 在总体人群以及 IgAN、MN、男性和女性亚群中与严重的 eGFR 下降相关，除 IgAN 外，在所有组的多变量调整中均具有统计学意义。然而，只有在女性患者中，SPS 与 eGFR 下降之间的关联在所有敏感性分析中仍然具有统计学意义。
SPS 与 IgAN 和 MN 女性患者的 eGFR 下降独立相关。
