Yamagata K, Yamagata Y, Kobayashi M, Koyama A
Department of Nephrology, Hitachi General Hospital, Ibaraki, Japan.
Clin Nephrol. 1996 May;45(5):281-8.
Between January 1, 1983 and December 31, 1992, 805 patients with asymptomatic proteinuria and/or hematuria were selected in the mass screening of 56,269 adults. We conducted prospective long-term follow-up studies of these patients and evaluated their clinical findings and renal histology. They were divided into three groups according to the first dipstick urinalysis findings: 478 patients with pure hematuria (H), 150 patients with concomitant hematuria and proteinuria (H & P), and 177 patients with proteinuria (P). The mean follow-up period was 5.80 +/- 4.42 years. Of the 478 patients with H, a specific cause of hematuria was found in 46 (9.6%), the remaining 432 (90.4%) patients were diagnosed as having asymptomatic hematuria (ASH). During the follow-up period, in the ASH patients, hematuria disappeared in 44.2%, 43.7% had persistent microhematuria without proteinuria, and 10.6% manifested proteinuria, none of the patients showed renal insufficiency. Of the 150 patients with H & P, 134 were diagnosed as having asymptomatic H & P. During the follow-up period, the hematuria and proteinuria disappeared in 16.4% of these patients, the proteinuria disappeared in 8.2%, and 14.9% of the patients showed renal insufficiency. Of the 177 patients with P, 151 were diagnosed has having asymptomatic P. During the follow-up period, proteinuria disappeared in 23.2%, and 10.6% showed renal insufficiency. Renal biopsy was performed in 151 patients in the study population who had a moderate degree of proteinuria; 68.2% of these patients had IgA nephropathy, 12.6% had non-IgA mesangial proliferative GN, 6.0% had membranous nephropathy, 5.3% had minimal change, and 2.6% had focal and segmental glomerular sclerosis. This study of the mass screening of urinalysis in asymptomatic adults showed that although the patients with pure hematuria did not exhibit renal insufficiency, 10.6% of these patients were proteinuric during the follow-up period. Therefore, careful observation and management are needed in these patients.
1983年1月1日至1992年12月31日期间，在对56269名成年人进行的大规模筛查中，选取了805例无症状蛋白尿和/或血尿患者。我们对这些患者进行了前瞻性长期随访研究，并评估了他们的临床检查结果和肾脏组织学情况。根据首次尿试纸分析结果，他们被分为三组：478例单纯血尿患者（H组）、150例血尿合并蛋白尿患者（H&P组）和177例蛋白尿患者（P组）。平均随访期为5.80±4.42年。在478例H组患者中，46例（9.6%）发现了血尿的特定病因，其余432例（90.4%）患者被诊断为无症状血尿（ASH）。在随访期间，ASH组患者中，44.2%的患者血尿消失，43.7%的患者持续存在微量血尿且无蛋白尿，10.6%的患者出现蛋白尿，无患者出现肾功能不全。在150例H&P组患者中，134例被诊断为无症状H&P。在随访期间，这些患者中16.4%的患者血尿和蛋白尿消失，8.2%的患者蛋白尿消失，14.9%的患者出现肾功能不全。在177例P组患者中，151例被诊断为无症状P。在随访期间，23.2%的患者蛋白尿消失，10.6%的患者出现肾功能不全。对研究人群中151例蛋白尿程度中等的患者进行了肾活检；这些患者中68.2%患有IgA肾病，12.6%患有非IgA系膜增生性肾小球肾炎，6.0%患有膜性肾病，5.3%患有微小病变，2.6%患有局灶节段性肾小球硬化。这项对无症状成年人尿液分析的大规模筛查研究表明，尽管单纯血尿患者未出现肾功能不全，但这些患者中有10.6%在随访期间出现蛋白尿。因此，需要对这些患者进行仔细观察和管理。
