Characteristics of patients with coexisting IgA nephropathy and membranous nephropathy.
Characteristics of patients with coexisting IgA nephropathy and membranous nephropathy.
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共存IgA肾病和膜性肾病患者的特点
DOI：
10.1080/0886022x.2018.1455591
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发表时间：
2018-11
期刊：
影响因子：
3
通讯作者：
Zhang H
中科院分区：
文献类型：
--
作者：
Chen P;Shi SF;Qu Z;Zhao N;Xie XF;Lv JC;Liu LJ;Zhang H
背景：同一患者同时存在IgA肾病(IgAN)和膜性肾病(MN)的情况很少见。有关IgAN合并MN(IgAN-MN)的临床和病理特点的研究报道较少。方法：比较IgAN-MN、IgAN和MN患者的临床病理特征、血清半乳糖缺乏性IgA1(Gd-IgA1)水平和抗M型跨膜磷脂酶A2受体自身抗体(抗PLA2R)。结果：26例经活检证实为IgAN-MN的患者入选。活检时的平均年龄为43.6 ± 15.9 ，其中男性占65.4%。IgAN-MN患者的蛋白尿和估计的肾小球滤过率(EGFR)水平与MN患者相似。与Ig AN组比较，Ig AN-MN组尿蛋白中位数(4.3vs.1.2 g/d，p <； .001)和平均水平(101.8 ± 25.4vs.78.6 ± 26.9 m L/m in/1.73 m~2，p <； .001)明显升高。根据牛津分类，IGAN-MN患者的病理损害比IgAN患者轻。IgAN-MN患者血清Gd-Ig A1水平与Ig AN患者相似(353.4 ± 95.5vs.347.0 ± 109.6 U/m L，p = .801)。血清抗PLA2受体阳性的IgAN-MN患者明显低于MN患者(38.5%vs.68.6%，p = .011)。结论：IGAN-MN患者的临床表现与MN患者相似，但病变较轻。IGAN-MN患者的Gd-IgA1水平与IgAN患者相似，抗PLA2R抗体比例低于MN患者。
Background: Coexistence of IgA nephropathy (IgAN) and membranous nephropathy (MN) in the same patient is rare. Few studies have reported the clinical and pathological features of patients with combined IgAN and MN (IgAN–MN). Methods: The clinico-pathological features, levels of galactose-deficient IgA1 (Gd-IgA1) and autoantibodies against M-type transmembrane phospholipase A2 receptor (anti-PLA2R) in sera were compared among IgAN–MN, IgAN, and MN patients. Results: Twenty-six patients with biopsy-proven IgAN–MN were enrolled. The mean age at biopsy was 43.6 ± 15.9 years, and 65.4% were male. Proteinuria and estimated glomerular filtration rate (eGFR) levels in patients with IgAN–MN were similar to that of MN patients. Compared with the IgAN patients, IgAN–MN patients showed a higher median proteinuria level (4.3 vs. 1.2 g/day, p < .001), and a higher mean eGFR level (101.8 ± 25.4 vs. 78.6 ± 26.9 mL/min/1.73 m2, p < .001). IgAN–MN patients presented with milder pathological lesions than IgAN patients according to the Oxford Classification. IgAN–MN patients had comparable serum levels of Gd-IgA1 with those of IgAN patients (353.4 ± 95.5 vs. 347.0 ± 109.6 U/mL, p = .801). Percentage of IgAN–MN patients with detectable serum levels of anti-PLA2R was lower than that of MN patients (38.5% vs. 68.6%, p = .011). Conclusions: IgAN–MN patients display similar clinical features to MN patients and milder pathological lesions than IgAN patients. IgAN–MN patients have similar levels of Gd-IgA1 to those of IgAN patients, and a lower proportion of anti-PLA2R than MN patients.