Radford M G, Donadio J V, Bergstralh E J, Grande J P
Division of Nephrology, Mayo Clinic and Foundation, Rochester, Minnesota, USA.
J Am Soc Nephrol. 1997 Feb;8(2):199-207. doi: 10.1681/ASN.V82199.
Immunoglobulin A (IgA) nephropathy, the most common form of glomerulonephritis worldwide, is characterized by a heterogeneous clinical course. In this study, multivariate analysis was performed to identify histopathologic and clinical features that most accurately predict adverse outcome from a dataset of 148 individuals with IgA nephropathy who underwent renal biopsy at our institution between 1973 and 1995. A semiquantitative scoring system was developed for assessment of six glomerular, eight interstitial, and six vascular histopathologic features of IgA nephropathy. Glomerular and interstitial proliferative activity was evaluated by immunostaining archival biopsy specimens with Mib-1, an antibody directed against the Ki-67 antigen. Kaplan-Meier survival analysis was performed, with renal failure being defined as onset of dialysis or transplantation. A number of clinicopathologic factors were univariately associated with adverse outcome, including elevated serum creatinine levels; the presence of hypertension; proteinuria; component and total histopathologic scores; and positive glomerular or interstitial Mib-1 scores. The total glomerular score, consisting of the arithmetic sum of each of the six component scores, was the strongest histopathologic predictor of adverse outcome. Total interstitial and vascular scores also provided more prognostic information than did individual component scores. By multivariate analysis, high total glomerular scores, increased serum creatinine levels at diagnosis, and younger age were significant (P < 0.01) independent predictors of renal failure. Our studies provide a rational basis for the inclusion of composite histopathologic scores in clinical intervention studies of patients with IgA nephropathy and other glomerular disorders.
免疫球蛋白A（IgA）肾病是全球最常见的肾小球肾炎形式，其临床病程具有异质性。在本研究中，我们进行了多变量分析，以从1973年至1995年间在我们机构接受肾活检的148例IgA肾病患者的数据集中，确定最准确预测不良结局的组织病理学和临床特征。我们开发了一种半定量评分系统，用于评估IgA肾病的六种肾小球、八种间质和六种血管组织病理学特征。通过用针对Ki-67抗原的抗体Mib-1对存档活检标本进行免疫染色，评估肾小球和间质的增殖活性。进行了Kaplan-Meier生存分析，将肾衰竭定义为透析或移植的开始。一些临床病理因素与不良结局单变量相关，包括血清肌酐水平升高；高血压的存在；蛋白尿；组织病理学成分和总分；以及肾小球或间质Mib-1评分阳性。由六个成分评分的算术和组成的肾小球总评分是不良结局最强的组织病理学预测指标。间质和血管总评分也比单个成分评分提供了更多的预后信息。通过多变量分析，高肾小球总评分、诊断时血清肌酐水平升高和年轻是肾衰竭的显著（P < 0.01）独立预测因素。我们的研究为在IgA肾病和其他肾小球疾病患者的临床干预研究中纳入综合组织病理学评分提供了合理依据。
