Abe S
Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Clin Nephrol. 1994 Feb;41(2):61-4.
The effect of pregnancy on long-term renal prognosis in women with IgA nephropathy is disputed. The clinical courses of 71 patients with biopsy proven IgA nephropathy were followed for 5 years. Thirty-six patients became pregnant during the first 2 years of follow-up (P), the remaining 35 never conceived (non-P). The pathology in preconception renal biopsy was similar to that of the women who never became pregnant. Glomerular filtration rate (GFR) was measured yearly as the 24 hour-clearance of creatinine and was compared between the two groups. Initial clinical data of the P and non-P were: average age 25 +/- 3: 25 +/- 3 (yrs); serum creatinine 0.8 +/- 0.2: 0.7 +/- 0.2 (mg/dl); GFR 83 +/- 15: 87 +/- 15 (ml/min); blood pressure 119 +/- 10/74 +/- 9: 121 +/- 17/71 +/- 8 (mmHg); proteinuria 0.6 +/- 0.4: 0.9 +/- 0.6 (g/day). There were no significant differences between the two groups. Average initial (83 +/- 15: 87 +/- 15) and final (69 +/- 28: 69 +/- 24) GFRs were comparable. In 80% of P and 74% of non-P patients, the GFR decrement was 25% or less at five years. Four of the P and two of the non-P progressed to end-stage renal failure and required hemodialysis. No adverse influence of gestation on the natural course of IgA nephropathy was detected.
妊娠对IgA肾病女性长期肾脏预后的影响存在争议。对71例经活检证实为IgA肾病的患者的临床病程进行了5年的随访。36例患者在随访的前2年怀孕（P组），其余35例从未怀孕（非P组）。孕前肾活检的病理情况与从未怀孕的女性相似。每年通过测定24小时肌酐清除率来测量肾小球滤过率（GFR），并在两组之间进行比较。P组和非P组的初始临床数据如下：平均年龄25±3岁：25±3岁；血清肌酐0.8±0.2：0.7±0.2（mg/dl）；GFR 83±15：87±15（ml/min）；血压119±10/74±9：121±17/71±8（mmHg）；蛋白尿0.6±0.4：0.9±0.6（g/天）。两组之间无显著差异。平均初始GFR（83±15：87±15）和最终GFR（69±28：69±24）具有可比性。在80%的P组患者和74%的非P组患者中，5年时GFR下降25%或更低。P组中有4例，非P组中有2例进展为终末期肾衰竭并需要血液透析。未检测到妊娠对IgA肾病自然病程有不良影响。
