T S Arjunlal, Kaliaperumal Thirumalvalavan, Fernando Edwin, D Srinivasaprasad N, Surendran Sujith, Annadurai Poongodi, Kurian Anila A
Nephrology, Stanley Medical College, Chennai, IND.
Nephrology, Government Stanley Medical College and Hospital, Chennai, IND.
Cureus. 2024 Aug 19;16(8):e67238. doi: 10.7759/cureus.67238. eCollection 2024 Aug.
Background and objective Infection-related glomerulonephritis (IRGN) in adults, particularly the diabetic population, has a grave prognosis with many patients progressing to dialysis-dependent renal failure. Indian data on this entity are very scarce. This study attempts to correlate the clinicopathological factors related to diabetic IRGN and its short-term outcomes. Subjects and methods A retrospective analysis of all diabetic patients with biopsy-proven IRGN between January 2017 and August 2021 was conducted. Factors affecting outcomes such as clinical characteristics, urine examination, complete blood count, serum biochemistry, renal biopsy, and follow-up data were obtained and analyzed to determine the risk of progression to chronic kidney disease (CKD)/end-stage renal disease (ESRD). Univariate/multivariate analysis and receiver operating characteristic (ROC) curve were performed to identify independent risk factors affecting outcomes. Results A total of 40 diabetic patients with IRGN was included in the study, with a mean age of 53.08 ± 10 years, comprising predominantly males (60%). Infective foci were occult in majority (37.5%). Isolated low C3 levels were documented in the majority, while three patients (7.5%) had normal complement levels. Complete renal recovery was noted in 15 patients (37.5%), while 12 patients (30%) progressed to ESRD. Anuria or uremia at presentation, glomerulosclerosis >28.6%, interstitial fibrosis with tubular atrophy (IFTA) >17.5%, and diabetic nephropathy correlated to poor renal recovery. No correlation was observed between endocapillary proliferation, the pattern of deposits, the prevalence of crescents, and complement levels with the outcome. Conclusion IRGN is a common immune-mediated clinical entity among diabetics and often requires renal replacement therapy. Anuria or uremia at presentation, diabetic nephropathy, elevated glomerulosclerosis, and IFTA were associated with poor renal recovery. Complement levels and crescents had no impact on the outcome.
背景与目的 成人感染相关性肾小球肾炎（IRGN），尤其是糖尿病患者群体，预后严重，许多患者会进展为依赖透析的肾衰竭。关于这一病症的印度数据非常稀少。本研究旨在关联与糖尿病性IRGN相关的临床病理因素及其短期预后。
对象与方法 对2017年1月至2021年8月间所有经活检证实为IRGN的糖尿病患者进行回顾性分析。获取并分析影响预后的因素，如临床特征、尿液检查、全血细胞计数、血清生化、肾活检及随访数据，以确定进展为慢性肾脏病（CKD）/终末期肾病（ESRD）的风险。进行单因素/多因素分析及受试者工作特征（ROC）曲线分析以识别影响预后的独立危险因素。
结果 本研究共纳入40例糖尿病性IRGN患者，平均年龄53.08±10岁，男性居多（60%）。多数患者（37.5%）感染灶隐匿。多数患者C3水平单独降低，而3例患者（7.5%）补体水平正常。15例患者（37.5%）实现完全肾脏恢复，12例患者（30%）进展为ESRD。就诊时无尿或尿毒症、肾小球硬化>28.6%、间质纤维化伴肾小管萎缩（IFTA）>17.5%以及糖尿病肾病与肾脏恢复不良相关。未观察到内皮细胞增生、沉积物类型、新月体患病率及补体水平与预后之间的相关性。
结论 IRGN是糖尿病患者中常见的免疫介导临床病症，常需肾脏替代治疗。就诊时无尿或尿毒症、糖尿病肾病、肾小球硬化升高及IFTA与肾脏恢复不良相关。补体水平和新月体对预后无影响。
