Berg U B, Widstam-Attorps U C
Department of Paediatrics, Karolinska Institute, Huddinge University Hospital, Sweden.
Pediatr Nephrol. 1993 Apr;7(2):123-9. doi: 10.1007/BF00864371.
Renal haemodynamics and urinary protein excretion (UPE) were investigated in 36 patients with IgA nephropathy more than 3 years after renal biopsy (mean interval 6.3 +/- 0.5 years). At follow-up, 39% of patients had a reduced glomerular filtration rate (GFR) and 11% endstage renal failure. Twenty-five percent had albuminuria, and a further 25% microalbuminuria. All albuminuric patients had GFRs below the mean, and 78% of the albuminurics had a reduced GFR. However, non-albuminurics also had decreased GFRs and GFR tended to fall with the duration of the disease in this group of patients. On comparing the histological changes in the biopsies with haemodynamic and UPE studies performed 6 years later, we found significant correlations between the extent of segmental glomerular sclerosis and GFR, effective renal plasma flow, urinary albumin and IgG excretion, respectively. Histological grading correlated with the same variables. Of the 4 uraemic patients, 2 were nephrotic at presentation, while the other 2 had a nephritic onset of disease and later developed heavy proteinuria. Three of their biopsies showed > or = 10% segmental glomerulosclerosis. Juvenile IgA nephropathy is not a harmless disease. Our results indicate that these children should be carefully monitored with adequate GFR measurements and urine protein analyses.
对36例肾活检后3年以上（平均间隔6.3±0.5年）的IgA肾病患者进行了肾脏血流动力学和尿蛋白排泄（UPE）研究。随访时，39%的患者肾小球滤过率（GFR）降低，11%进入终末期肾衰竭。25%的患者有白蛋白尿，另有25%有微量白蛋白尿。所有白蛋白尿患者的GFR均低于平均水平，78%的白蛋白尿患者GFR降低。然而，非白蛋白尿患者的GFR也有所下降，且在该组患者中GFR倾向于随疾病持续时间而下降。将活检的组织学变化与6年后进行的血流动力学和UPE研究进行比较时，我们发现节段性肾小球硬化程度分别与GFR、有效肾血浆流量、尿白蛋白和IgG排泄之间存在显著相关性。组织学分级与相同变量相关。在4例尿毒症患者中，2例初诊时为肾病综合征，另外2例起病为肾炎型，随后出现大量蛋白尿。他们的3份活检显示节段性肾小球硬化≥10%。青少年IgA肾病并非无害疾病。我们的结果表明，应对这些儿童进行仔细监测，进行充分的GFR测量和尿蛋白分析。
