Histologic characterization and risk factors for persistent albuminuria in adolescents in a region of highly prevalent end-stage renal failure of unknown origin.
Histologic characterization and risk factors for persistent albuminuria in adolescents in a region of highly prevalent end-stage renal failure of unknown origin.
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不明原因终末期肾衰竭高发地区青少年持续性白蛋白尿的组织学特征和危险因素
DOI：
10.1093/ckj/sfac018
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发表时间：
2022-07
影响因子：
4.6
通讯作者：
中科院分区：
文献类型：
--
作者：
不明原因的终末期肾衰竭（ESRD-UO）是墨西哥和世界许多地区的公共卫生问题。墨西哥阿瓜斯卡连特斯的ESRD-UO患病率是世界上最高的之一，特别是在20至40岁的成年人中。我们的目的是筛查青少年慢性肾脏病（CKD），以确定危险因素和组织学特征的青少年持续性蛋白尿。这是一项针对青少年的横断面、观察性和比较性研究，在筛查CKD时测定血清肌酐和白蛋白：肌酐比值（ACR）。进行了临床评价和危险因素调查。对ACR异常（≥30 mg/g）或肾小球滤过率（GFR）低（≤75 mL/min/1.73 m2）的患者进行重新评价，并进行肾脏超声（US）检查。对持续性蛋白尿患者进行肾活检。共有513名学生被纳入，其中19名有持续性蛋白尿，494名为对照组。持续性白蛋白尿的患病率为3.7% [95%置信区间（CI）2.1-5.3]。只有1例患者GFR降低。持续性白蛋白尿的患者中，肾脏超声均未发现泌尿道解剖异常。与对照组相比，持续性白蛋白尿患者的肾脏总体积减少（150 vs 195 mL/m2; P < 0.01）。足细胞异常在电子显微镜下明显，包括部分融合（100%），微绒毛变性（80%）和细胞器增加（60%）。持续性蛋白尿的危险因素有：宅基地靠近玉米作物，在父亲的工作场所使用杀虫剂，CKD家族史和血压异常。体重指数和母乳喂养是保护因素。阿瓜斯卡连特斯地区青少年持续性蛋白尿的患病率很高，组织学损害的特征是在没有纤维化的情况下足细胞损伤。持续性白蛋白尿患者的肾脏体积减少，提示肾功能减少。暴露于环境毒素，如农药，甚至产前，可能是负责这种病理实体。在这种情况下，通过确定ACR对青少年进行筛查是必要的。
End-stage renal failure of unknown origin (ESRD-UO) is a public health problem in Mexico and many regions of the world. The prevalence of ESRD-UO in Aguascalientes, Mexico, is one of the highest worldwide, particularly in adults between 20 and 40 years of age. Our aim was to screen adolescents for chronic kidney disease (CKD) to identify risk factors and histologically characterize adolescents with persistent albuminuria. This was a cross-sectional, observational and comparative study of adolescents in whom serum creatinine and the albumin:creatinine ratio (ACR) were determined when screening for CKD. A clinical evaluation and risk factor survey were conducted. Patients with an abnormal ACR (≥30 mg/g) or a low glomerular filtration rate (GFR) (≤75 mL/min/1.73 m2) were re-evaluated and a renal ultrasound (US) was obtained. A kidney biopsy was performed in patients with persistent albuminuria. A total of 513 students were included; 19 had persistent albuminuria and 494 were controls. The prevalence of persistent albuminuria was 3.7% [95% confidence interval (CI) 2.1–5.3]. Only one patient had a decreased GFR. None of the patients with persistent albuminuria had anatomical abnormalities of the urinary tract by renal US. Patients with persistent albuminuria had a decreased total renal volume compared with the control group (150 versus 195 mL/m2; P < 0.01). Eighteen kidney biopsies were performed; 72% had glomerulomegaly and only one patient had mild fibrosis. Podocyte abnormalities were evident on electron microscopy, including partial fusion (100%), microvillous degeneration (80%) and increased organelles (60%). Risk factors for persistent albuminuria were: homestead proximity to maize crops, the use of pesticides at the father’s workplace, a family history of CKD and blood pressure abnormalities. The body mass index and breastfeeding were protective factors. The prevalence of persistent albuminuria in adolescents in Aguascalientes is high and histologic compromise is characterized by podocyte injury in the absence of fibrosis. The renal volume of persistent albuminuria patients was decreased, suggesting oligonephronia. Exposure to environmental toxins such as pesticides, even prenatally, may be responsible for this pathological entity. Screening programs in adolescents by determining ACR are necessary in this setting.
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影响因子：
5.9
作者：
Plaza-Díaz J;Fontana L;Gil A
通讯作者：
Gil A
影响因子：
4.6
作者：
Gutierrez-Peña M;Zuñiga-Macias L;Marin-Garcia R;Ovalle-Robles I;García-Díaz AL;Macías-Guzmán MJ;Delgado-Bentites A;Macías-Diaz DM;Prado-Aguilar CA;Vega de la Rosa A;Delgadillo-Castañeda R;Chew-Won A;Reyes-Acevedo R;Reyes-Campos DM;Martínez-Guevara MA;Mendoza-Enciso EA;Nava-Becerra B;Piza-Jiménez MA;Arreola Guerra JM
通讯作者：
Arreola Guerra JM
影响因子：
11.8
作者：
Kang，Habyeong;Lee，Jeonghwan;Choi，Kyungho
通讯作者：
Choi，Kyungho
影响因子：
19.6
作者：
Fischer, Rebecca S. B.;Vangala, Chandan;Murray, Kristy O.
通讯作者：
Murray, Kristy O.
影响因子：
158.5
作者：
NOVICK, AC;GEPHARDT, G;TUBBS, RR
通讯作者：
TUBBS, RR