University of Tours, Tours, France.
Department of Nephrology, Hopital Bretonneau, CHRU de Tours, Tours, France.
J Nephrol. 2023 Mar;36(2):485-494. doi: 10.1007/s40620-022-01389-8. Epub 2022 Aug 13.
Indications for kidney biopsy in adult IgA vasculitis (IgAV) remain debated and there are very few studies on this subject. The aim of this study was to establish a correlation between renal histological and clinical-laboratory data.
A retrospective multicenter study was conducted using three databases from French hospitals, gathered between 1977 and 2020. The study included 294 adult patients with IgAV who had undergone kidney biopsy assessed according to the prognostic "Pillebout classification". Different statistical models were used to test the correlations between histological and clinical-laboratory data: Cochran Armitage, ANOVA, Kruskal-Wallis and logistic regression.
The patients were primarily men (64%), with a mean age of 52 years. The main organs and tissues involved were: dermatological 100%, digestive 48% and rheumatological 61%. All had features of kidney involvement. The median serum creatinine was 96 µmol/L serum albumin 35 g/L, and C-reactive protein 28 mg/L. Of the patients, 86% (n = 254) had hematuria and median proteinuria was 1.8 g/day. The only statistically significant correlation between the pathological stages and the clinical-laboratory data was the presence of hematuria (p = 0.03, 66% class I to 92% class IV). In multivariate analysis, only albuminemia was associated with extracapillary proliferation (p = 0.02; OR 0.94) and only age was associated with stages 3-4 (p = 0.03; OR 1.02).
Our study suggests that there is no strict baseline correlation between renal pathology and clinical-laboratory data. Given the current knowledge, it seems relevant to recommend a kidney biopsy in the presence of significant and persistent proteinuria or unexplained kidney function decline.
成人 IgA 血管炎（IgAV）行肾活检的适应证仍存在争议，关于该主题的研究很少。本研究旨在建立肾脏组织学和临床-实验室数据之间的相关性。
采用回顾性多中心研究，使用来自法国医院的三个数据库，时间范围为 1977 年至 2020 年。研究纳入了 294 例接受过肾活检的 IgAV 成年患者，评估方法采用预测性“Pillebout 分类”。采用 Cochran-Armitage、方差分析、Kruskal-Wallis 和逻辑回归等不同统计模型检验组织学和临床-实验室数据之间的相关性。
患者主要为男性（64%），平均年龄为 52 岁。主要受累器官和组织为：皮肤 100%、消化系统 48%和风湿系统 61%。所有患者均有肾脏受累的特征。血清肌酐中位数为 96μmol/L，血清白蛋白 35g/L，C 反应蛋白 28mg/L。86%（n=254）的患者有血尿，尿蛋白中位数为 1.8g/天。病理分期与临床-实验室数据之间唯一具有统计学意义的相关性为血尿的存在（p=0.03，I 级至 IV 级分别为 66%和 92%）。多变量分析显示，仅白蛋白血症与毛细血管外增生相关（p=0.02；OR 0.94），仅年龄与 3-4 期相关（p=0.03；OR 1.02）。
本研究提示，肾脏病理与临床-实验室数据之间没有严格的基线相关性。根据现有知识，在存在明显且持续的蛋白尿或原因不明的肾功能下降时，建议行肾活检似乎是合理的。
