Podocyte Detachment Is Associated with Renal Prognosis in ANCA-Associated Glomerulonephritis: A Retrospective Cohort Study.
Podocyte Detachment Is Associated with Renal Prognosis in ANCA-Associated Glomerulonephritis: A Retrospective Cohort Study.
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DOI：
10.1097/md.0000000000003294
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发表时间：
2016-04
期刊：
影响因子：
1.6
通讯作者：
Zhao MH
中科院分区：
文献类型：
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作者：
Zou R;Wang SX;Liu G;Yu F;Chen M;Zhao MH
抗中性粒细胞胞浆抗体(ANCA)相关性肾炎(ANCA-GN)虽然接受免疫抑制治疗，但预后不良。有人认为足细胞的丢失是进行性肾脏疾病的一个标志。然而，目前尚不清楚足细胞损伤及其对ANCA-GN预后的预测价值。因此，本研究旨在探讨ANCA-GN患者肾脏组织病理学中足细胞损伤及其与肾脏预后的关系。本研究共纳入170例ANCA-GN患者。对ANCA-GN患者足突宽度(FPW)、肾小球足细胞密度(NV)和肾小球基底膜(GBM)宽度进行了测量和计算。用Cox回归分析足细胞损伤与ANCA-GN患者预后的关系。光镜下可见足突增宽158例(92.9%)，足细胞脱离142例(83.5%)，基底膜增厚150例(88.2%)。与正常对照组比较，ANCA-GN患者足细胞密度显著降低(1269.39 ± 680.19 vs 585.81 ± 77.16，P = 0.004；668.23 ± 208.73 vs 354.23 ± 52.70，P = 0.000)，足细胞密度显著降低(55.9 ± 36.32 vs 255.23 ± 47.29，P = 0.000)。Logistic回归分析显示，足细胞密度与肾功能恢复独立相关(OR，1.083；95%CI，1.025~1.440；P = 0.005)。多因素分析显示，足细胞密度是终末期肾病的独立预测因子(模型A：HR，0.950；95%CI，0.919~1.982；P = 0.002；模型B：HR，0.953；95%CI，0.922~0.985；P = 0.004)。ANCA-GN患者常发生足细胞结构破坏和脱离。此外，足细胞脱离是肾脏预后的独立预测因子。
The prognosis of antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN) is unfavorable despite immunosuppressive therapy. It has been suggested that the loss of podocytes is a hallmark of progressive kidney disease. However, it is unclear about podocyte injuries and their predictive values on the prognosis in ANCA-GN. Therefore, the current study aimed to investigate the podocyte injury in renal histopathology and its association with renal prognosis of patients with ANCA-GN. A total of 170 patients with ANCA-GN were recruited in this study. Morphometric investigation of podocytes by electron microscopy including foot process width (FPW), podocyte density per glomerulus (Nv), and glomerular basement membrane (GBM) width were measured and calculated in ANCA-GN patients. Cox regression analysis was used to analyze the association between podocyte injuries and prognosis of patients with ANCA-GN. Foot processes broadening, podocyte detachment, and GBM thickening could be observed in electron micrographs in the specimens of 158/170 (92.9%), 142/170 (83.5%), and 150/170 (88.2%) patients, respectively. Compared with normal controls, FPW and GBM width in ANCA-GN patients was significantly higher (1269.39 ± 680.19 vs 585.81 ± 77.16, P = 0.004; 668.23 ± 208.73 vs 354.23 ± 52.70, P = 0.000, respectively), while the podocyte density was significantly lower (55.90 ± 36.32 vs 255.23 ± 47.29, P = 0.000). The podocyte density was independently associated with the recovery of renal function in logistic regression analysis (OR, 1.083; 95% CI, 1.025–1.440; P = 0.005). Furthermore, multivariate analysis revealed that podocyte density was an independent predictor of end-stage renal disease (ESRD) (model A: HR, 0.950; 95% CI, 0.919–1.982; P = 0.002; model B: HR, 0.953; 95% CI, 0.922–0.985; P = 0.004). Podocyte structural damage and detachment occurred frequently in patients with ANCA-GN. Moreover, podocyte detachment was an independent predictor of renal outcomes.