Korbet S M, Genchi R M, Borok R Z, Schwartz M M
Department of Medicine, Rush-Presbyterian-St Lukes Medical Center, Chicago, IL, USA.
Am J Kidney Dis. 1996 May;27(5):647-51. doi: 10.1016/s0272-6386(96)90098-0.
We retrospectively evaluated the prevalence of primary glomerular lesions in adults who had a renal biopsy for nephrotic proteinuria. From July 1975 to May 1994, 340 patients undergoing renal biopsies evaluated at Rush-Presbyterian-St Lukes Medical Center had the primary glomerular lesions of minimal-change disease, focal segmental glomerular sclerosis (FSGS), membranous glomerulonephritis (MGN), membranoproliferative glomerulonephropathy, immunoglobulin A nephropathy, and immunotactoid glomerulopathy. The patients had a mean age of 43 +/- 17 years, 57% were male, and 50% were white, 36% were black, 7% were of other race, and 7% were of unknown race. The distribution of lesions for black patients was minimal-change disease 14%, FSGS 57%, MGN 24%, membranoproliferative glomerulonephritis 2%, immunoglobulin A 2%, and immunotactoid glomerulopathy 1%; for white patients, the distribution of lesions was minimal-change disease 20%, FSGS 23%, MGN 36%, membranoproliferative glomerulonephropathy 6%, immunoglobulin A 8%, and immunotactoid glomerulopathy 6%. The prevalence of FSGS was significantly greater (P < 0.0001) and that for MGN, immunoglobulin A, and immunotactoid glomerulopathy was significantly less (P < 0.05) for black patients compared with white patients. In a logistic regression analysis, race remained the only significant predictor of FSGS (P = 0.0001), with black patients four times as likely to have FSGS as white patients. The distribution of lesions among white patients was similar based on gender, age, and biopsy period. For black patients the distribution was also similar based on gender and age, but over 20 years the incidence of FSGS increased from 39% (1975 to 1984) to 64% (1985 to 1994) (P < 0.01). Thus, significant racial differences in the distribution of primary glomerular lesions exists. This has important prognostic and therapeutic implications for nephrotic adults.
我们回顾性评估了因肾病性蛋白尿接受肾活检的成年患者原发性肾小球病变的患病率。1975年7月至1994年5月，在拉什长老会圣卢克医疗中心接受肾活检评估的340例患者患有微小病变性肾病、局灶节段性肾小球硬化（FSGS）、膜性肾小球肾炎（MGN）、膜增生性肾小球肾炎、免疫球蛋白A肾病和免疫触须样肾小球病等原发性肾小球病变。患者的平均年龄为43±17岁，57%为男性，50%为白人，36%为黑人，7%为其他种族，7%种族不明。黑人患者的病变分布为微小病变性肾病14%、FSGS 57%、MGN 24%、膜增生性肾小球肾炎2%、免疫球蛋白A 2%、免疫触须样肾小球病1%；白人患者的病变分布为微小病变性肾病20%、FSGS 23%、MGN 36%、膜增生性肾小球肾炎6%、免疫球蛋白A 8%、免疫触须样肾小球病6%。与白人患者相比，黑人患者FSGS的患病率显著更高（P<0.0001），而MGN、免疫球蛋白A和免疫触须样肾小球病的患病率显著更低（P<0.05）。在逻辑回归分析中，种族仍然是FSGS的唯一显著预测因素（P = 0.0001），黑人患者患FSGS的可能性是白人患者的四倍。白人患者中病变的分布在性别、年龄和活检时期方面相似。对于黑人患者，基于性别和年龄分布也相似，但在20年期间，FSGS的发病率从39%（1975年至1984年）增加到64%（1985年至1994年）（P<0.01）。因此，原发性肾小球病变的分布存在显著的种族差异。这对成年肾病患者具有重要的预后和治疗意义。
