Jönsson Anneli, Hellmark Thomas, Segelmark Mårten, Forsberg Anna, Dreja Karl
Department of Clinical Sciences, Lund University, Lund, Sweden.
Department of Health Science, Lund University, Lund, Sweden.
Front Nephrol. 2023 Mar 17;3:1026864. doi: 10.3389/fneph.2023.1026864. eCollection 2023.
Many pathological processes can disrupt the integrity of the glomerular capillary wall and cause a massive leakage of protein, resulting in nephrotic syndrome (NS). Clinical parameters such as age, sex, renal function, presence of diabetes, and how NS is defined influence the spectrum of underlying diseases. In this study, we examine how these parameters interact.
Age, sex, hematuria, proteinuria, plasma creatinine plasma albumin levels, and final diagnosis were retrieved for all adult patients with NS as an indication for biopsy and/or massive albuminuria in conjunction with low plasma albumin from the biopsy module of the Swedish Renal Registry (SRR) between 2014 and 2019. A basic calculator was developed to demonstrate the importance of clinical presentation in relation to the likelihood of having a specific diagnosis.
A total of 913 unique patients were included in the study. Diabetic nephropathy (DN) and membranous nephropathy (MN) (both found in 17% of patients) were the most common diagnoses. With a stringent definition of NS, MN and minimal change nephropathy (MCN) increased in proportion. Among the cohort as a whole, MCN was the most frequent diagnosis in women and those < 50 years of age (found in 21% and 17%, respectively). In the case of patients aged between 50 and 70 years, those with chronic kidney disease stage 4, and those with negative dipstick tests for hematuria, the most common underlying disease was DN (in 23%, 30%, and 21% of cases, respectively). Among those with high-grade hematuria (dipstick grade 3 or 4), membranoproliferative glomerulonephritis was the most common diagnosis (14%), closely followed by IgA nephropathy (13%). Focal segmental glomerulosclerosis (9.7%) was less common than in many comparable studies.
Clinical parameters have a profound impact on the likelihood of different diagnoses in adult patients with NS. Differences in clinical practice and study inclusion criteria may be more important than genetic background and environmental factors when explaining differences between studies in different parts of the world.
许多病理过程可破坏肾小球毛细血管壁的完整性，导致大量蛋白质泄漏，从而引发肾病综合征（NS）。年龄、性别、肾功能、糖尿病的存在以及NS的定义等临床参数会影响潜在疾病的范围。在本研究中，我们探究了这些参数之间的相互作用。
检索了2014年至2019年间瑞典肾脏登记处（SRR）活检模块中所有因活检和/或大量蛋白尿合并低血浆白蛋白而患有NS的成年患者的年龄、性别、血尿、蛋白尿、血浆肌酐、血浆白蛋白水平及最终诊断结果。开发了一个基本计算器以证明临床表现与特定诊断可能性之间的重要性。
该研究共纳入913例独特患者。糖尿病肾病（DN）和膜性肾病（MN）（均在17%的患者中发现）是最常见的诊断。采用严格的NS定义时，MN和微小病变肾病（MCN）的比例增加。在整个队列中，MCN是女性和年龄＜50岁患者中最常见的诊断（分别为21%和17%）。对于年龄在50至70岁之间的患者、慢性肾脏病4期患者以及血尿试纸检测呈阴性的患者，最常见的潜在疾病是DN（分别占病例的23%、30%和21%）。在重度血尿（试纸分级为3级或4级）患者中，膜增生性肾小球肾炎是最常见的诊断（14%），紧随其后的是IgA肾病（13%）。局灶节段性肾小球硬化（9.7%）比许多类似研究中的情况少见。
临床参数对成年NS患者不同诊断的可能性有深远影响。在解释世界不同地区研究之间的差异时，临床实践和研究纳入标准的差异可能比遗传背景和环境因素更重要。
