儿童少量蛋白尿 IgA 肾病：是否行肾活检？
IgA nephropathy in children with minimal proteinuria: to biopsy or not to biopsy?
机构信息
Division of Nephrology, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, QC, Canada.
Sainte-Justine Hospital Pediatric Research Centre: Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, QC, Canada.
出版信息
Pediatr Nephrol. 2024 Mar;39(3):781-787. doi: 10.1007/s00467-023-06121-7. Epub 2023 Sep 12.
BACKGROUND
Tubulointerstitial lesions and glomerular inflammation severity have been shown to correlate with proteinuria in children with IgA nephropathy (cIgAN). However, there is a lack of data regarding severity of histopathologic findings in cIgAN in patients with minimal to absent proteinuria since kidney biopsy indications are not well defined in these cases.
METHODS
Twenty-eight cIgAN patients with kidney biopsy from 4 different centers in Paris (France) and Montreal (Canada) with a urine protein/creatinine ratio (UPCr) ≤ 0.03 g/mmol and a normal estimated glomerular filtration rate (eGFR > 90 ml/min/1.73 m) on the day of kidney biopsy prior to treatment were included.
RESULTS
Median age was 11.82 (9.32-13.45) years, and median follow-up was 4 years (2.87-6.53). At time of biopsy, median eGFR was 116 (102.3-139.7) ml/min/1.73 m, and median UPCr was 0.02 (0.011-0.03) g/mmol. Microscopic or macroscopic hematuria was present in 35.7% and 64.3% of cases, respectively. Kidney biopsy microscopy analysis showed mesangial (M1), endocapillary (E1), or extracapillary (C1) hypercellularity in 53.5%, 32.1%, and 7.1% of patients, respectively. Chronic histological lesions were also present: glomerulosclerosis (S1) in 42.8% and tubular atrophy/interstitial fibrosis in 7.1%. Podocytopathic features were detected in 21.4%. An ACE inhibitor or immunosuppressive therapy (IS) was prescribed in 42.8% and 21.4% of these patients respectively. One-third (35.7%) received no treatment. At last follow-up, median eGFR was 111.9 (90.47-136.1) ml/min/1.73 m, and median UPCr was 0.028 (0.01-0.03) g/mmol.
CONCLUSION
cIgAN with minimal proteinuria at time of biopsy might be linked with acute and chronic glomerular lesions.
背景
在 IgA 肾病（cIgAN）患儿中，已证实肾小管间质病变和肾小球炎症严重程度与蛋白尿相关。然而，在这些情况下，由于肾脏活检指征尚未明确，因此对于蛋白尿微量至无的 cIgAN 患者的组织病理学发现严重程度缺乏数据。
方法
28 例 cIgAN 患者来自法国巴黎和加拿大蒙特利尔的 4 个不同中心的肾脏活检，在治疗前的肾活检当日尿蛋白/肌酐比值（UPCr）≤0.03 g/mmol，且估算肾小球滤过率（eGFR）正常（>90 ml/min/1.73 m2）。
结果
中位年龄为 11.82（9.32-13.45）岁，中位随访时间为 4 年（2.87-6.53）。在活检时，中位 eGFR 为 116（102.3-139.7）ml/min/1.73 m2，中位 UPCr 为 0.02（0.011-0.03）g/mmol。分别有 35.7%和 64.3%的病例存在镜下或肉眼血尿。肾脏活检显微镜分析显示，系膜（M1）、内皮层（E1）或细胞外（C1）细胞增生分别见于 53.5%、32.1%和 7.1%的患者。也存在慢性组织学病变：肾小球硬化（S1）见于 42.8%，肾小管萎缩/间质纤维化见于 7.1%。足细胞病变特征见于 21.4%。分别有 42.8%和 21.4%的患者接受了血管紧张素转换酶抑制剂或免疫抑制治疗（IS）。三分之一（35.7%）的患者未接受治疗。在最后一次随访时，中位 eGFR 为 111.9（90.47-136.1）ml/min/1.73 m2，中位 UPCr 为 0.028（0.01-0.03）g/mmol。
结论
活检时蛋白尿微量的 cIgAN 可能与急性和慢性肾小球病变有关。
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