Buckheit J B, Olshen R A, Blouch K, Myers B D
Department of Statistics, Stanford University School of Medicine, California 94305, USA.
Am J Physiol. 1997 Jul;273(1 Pt 2):F158-69. doi: 10.1152/ajprenal.1997.273.1.F158.
We studied glomerular function longitudinally for 36-120 mo in 21 patients undergoing treatment for diffuse, proliferative lupus nephritis. We determined glomerular filtration rate (GFR) and glomerular oncotic pressure (IIGC) and computed the two-kidney ultrafiltration coefficient (Kf) at 6- to 12-mo intervals. The relationships and cross talk among the three variables over time were then analyzed by eigenfunction regression and canonical correlations. We also performed a morphometric analysis of serial biopsies and computed single-nephron Kf in patent glomeruli at baseline and after 36-94 mo of follow-up. Patients were divisible into progressors (n = 12) or nonprogressors (n = 9) according to the presence or absence, respectively, of an irrevocable decline in GFR over time. Examination of longitudinal variables revealed GFR to be strongly related to Kf in all patients and inversely related to IIGC in progressors. By serial morphometric analysis we observed a threefold increase in the prevalence of global sclerosis in progressors but unchanged prevalence in nonprogressors. Whereas single-nephron Kf of remnant glomeruli increased to supernormal levels in nonprogressors, the absence of this compensatory phenomenon in progressors permitted GFR and Kf to decline in parallel with the declining number of functional glomeruli.
我们对21例正在接受弥漫性增殖性狼疮性肾炎治疗的患者进行了36至120个月的肾小球功能纵向研究。我们每隔6至12个月测定肾小球滤过率（GFR）和肾小球胶体渗透压（IIGC），并计算双肾超滤系数（Kf）。然后通过特征函数回归和典型相关性分析这三个变量随时间的关系和相互作用。我们还对系列活检进行了形态计量分析，并计算了基线时和随访36至94个月后存活肾小球的单肾单位Kf。根据GFR是否随时间出现不可逆转的下降，患者可分为病情进展者（n = 12）或非进展者（n = 9）。对纵向变量的检查显示，在所有患者中GFR与Kf密切相关，而在病情进展者中GFR与IIGC呈负相关。通过系列形态计量分析，我们观察到病情进展者中全球硬化的患病率增加了两倍，而非进展者中患病率没有变化。在非进展者中，残余肾小球的单肾单位Kf增加到超常水平，而病情进展者中缺乏这种代偿现象，使得GFR和Kf随着功能性肾小球数量的减少而平行下降。
