Ruggenenti P, Perna A, Mosconi L, Matalone M, Pisoni R, Gaspari F, Remuzzi G
Mario Negri Institute for Pharmacological Research, Aldo e Cele Daccò Villa Camozzi, Ranica, Italy.
Kidney Int Suppl. 1997 Dec;63:S54-7.
We correlated baseline parameters with glomerular filtration rate (GFR) decline and kidney survival in 274 patients with proteinuric non-diabetic chronic nephropathies (creatinine clearance 20 to 70 ml/min/1.73 m2 and proteinuria > 1 g/24 hr over the last three months) enrolled in the Ramipril Efficacy In Nephropathy (REIN) trial. The GFR, evaluated at baseline, one, three and six months after randomization then every six months, declined linearly by 0.52 +/- 0.83 ml/min/1.73 m2/month (mean +/- SD) over a follow-up (median: range) of 21:3 to 52 months, and kidney survival was 64%. In multivariate analysis, higher baseline proteinuria (P = 0.006), and lower GFR (P = 0.0001) and creatinine clearance (P = 0.0001) correlated with a faster GFR decline. Higher proteinuria was the only baseline predictor of a shorter kidney survival (P = 0.0007) and its predictive value was independent of the underlying renal disease, treatment randomization, and blood pressure control during the followup. Patients in the lowest tertile of baseline proteinuria (< 2.5 g/24 hr) had the slowest rate of GFR decline (-0.25 +/- 0.72 ml/min/1.73 m2/month) and the highest kidney survival (94%), compared with patients in the middle tertile (proteinuria 2.5 to 4.3 g/24 hr; delta GFR, -0.59 +/- 0.82 ml/min/1.73 m2/month, P = 0.008; kidney survival 57%, P = 0.0011) and in the highest tertile (proteinuria > 4.3 g/24 hr; delta GFR, -0.79 +/- 0.87 ml/min/1.73 m2/month, P = 0.0001, kidney survival 44%, P = 0.0001). Kidney survival significantly differed even between the middle and highest tertiles (P < 0.05). Thus, in non-diabetic chronic nephropathies proteinuria is an independent and accurate predictor of disease progression and ESRF.
我们将274例蛋白尿性非糖尿病慢性肾病患者（肌酐清除率为20至70 ml/min/1.73 m²，过去三个月蛋白尿>1 g/24小时）的基线参数与肾小球滤过率（GFR）下降及肾脏存活率进行了关联分析。这些患者均参与了雷米普利肾病疗效（REIN）试验。随机分组后1个月、3个月、6个月及之后每6个月评估一次GFR，在21.3至52个月的随访期（中位数：范围）内，GFR以0.52±0.83 ml/min/1.73 m²/月（均值±标准差）的速度呈线性下降，肾脏存活率为64%。多因素分析显示，较高的基线蛋白尿水平（P = 0.006）、较低的GFR（P = 0.0001）和肌酐清除率（P = 0.0001）与GFR更快下降相关。较高的蛋白尿水平是肾脏存活时间缩短的唯一基线预测因素（P = 0.0007），其预测价值独立于潜在的肾脏疾病、治疗随机分组以及随访期间的血压控制情况。与处于蛋白尿中间三分位数（蛋白尿2.5至4.3 g/24小时；GFR变化量，-0.59±0.82 ml/min/1.73 m²/月，P = 0.008；肾脏存活率57%，P = 0.0011）和最高三分位数（蛋白尿>4.3 g/24小时；GFR变化量，-0.79±0.87 ml/min/1.73 m²/月，P = 0.0001，肾脏存活率44%，P = 0.0001）的患者相比，基线蛋白尿处于最低三分位数（<2.5 g/24小时）的患者GFR下降速度最慢（-0.25±0.72 ml/min/1.73 m²/月）且肾脏存活率最高（94%）。即使在蛋白尿中间三分位数和最高三分位数的患者之间，肾脏存活率也存在显著差异（P < 0.05）。因此，在非糖尿病慢性肾病中，蛋白尿是疾病进展和终末期肾衰竭的独立且准确的预测指标。
