Regression of IgA nephropathy: A repeat biopsy study
Regression of IgA nephropathy: A repeat biopsy study
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DOI：
10.1053/ajkd.2002.31399
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发表时间：
2002-03-01
影响因子：
13.2
通讯作者：
Taguma, Y
中科院分区：
文献类型：
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作者：
Hotta, O;Furuta, T;Taguma, Y
免疫球蛋白A(IgA)肾病的组织学治愈在成人中的报道很少。为了阐明已建立的IgA肾病的可逆性，我们进行了重复的活检研究。对35例经大剂量甲基强的松龙和扁桃体切除术后血尿消失(23例蛋白尿也消失)的IgA肾病患者进行了第二次活检。第一次活检与第二次活检的间隔时间为18~138个月，平均77.1个月。第一次活检时平均血肌酐为1.11+/-0.35(SD)mg/dL(0.6~1.9 mg/dL)，第二次活检时为0.96+/-0.24 mg/dL。在二次活检标本中，系膜增殖显著减少(系膜增殖评分：第一次活检标本2.49+/-0.74；第二次活检标本0.91+/-0.89；P<；0.001)。在第一次活检标本中，32例患者出现急性炎性肾小球病变，如毛细血管内增殖、肾小球簇状坏死和细胞新月体，而在第二次活检标本中，这些病变都不再存在。虽然第一次活检标本和第二次活检标本之间整体硬化肾小球的百分比没有显著差异，但在第二次活检标本中节段性硬化肾小球的百分比显著降低(P<；0.001)。在第二次活检标本中，间质单个核细胞的浸润明显减少(P<；0.001)。肾皮质间质纤维化和/或水肿的面积在第二次活检标本中显著减少(第一次活检标本21.4%+/-20.3%；第二次活检标本9.6%+/-11.7%；P<；0.01)。大部分患者IgA系膜沉积减少，8例二次活检标本中未见IgA沉积。这些结果表明，IgA肾病的系膜细胞增殖和间质改变在相当程度上是可逆的。在相当一部分患者中可以获得组织学治愈，特别是如果在相对较早的阶段开始治疗的话。(C)2002年，由国家肾脏基金会公司提供。
Histological cure of immunoglobulin A (IgA) nephropathy has been reported only rarely in adults. To elucidate the reversibility of established IgA nephropathy, we performed a repeat biopsy study. A second biopsy was performed in 35 patients with IgA nephropathy in whom hematuria, an essential finding of IgA nephropathy, had disappeared (proteinuria also had disappeared in 23 patients) after a treatment protocol involving high doses of methylprednisolone and tonsillectomy. The interval between the first and second biopsy was 18 to 138 months (mean, 77.1 months). Mean serum creatinine level was 1.11 +/- 0.35 (SD) mg/dL (range, 0.6 to 1.9 mg/dL) at the time of the first biopsy and 0.96 +/- 0.24 mg/dL at the time of the second biopsy. Mesangial proliferation was significantly reduced in second-biopsy specimens (mesangial proliferation score: first-biopsy specimens, 2.49 +/- 0.74; second-biopsy specimens, 0.91 +/- 0.89; P < 0.001). Acute inflammatory glomerular lesions, such as endocapillary proliferations, glomerular tuft necrosis, and cellular crescents, were present in 32 patients in first-biopsy specimens, whereas these were no longer present in any of the second-biopsy specimens. Although no significant difference in percentage of globally sclerotic glomeruli was observed between the first and second biopsy specimens, the percentage of segmentally sclerotic glomeruli was significantly lower in second-biopsy specimens (P < 0.001). Interstitial mononuclear cell infiltration was markedly reduced in second-biopsy specimens (P < 0.001). The area of renal cortex affected by interstitial fibrosis and/or edema was significantly reduced in second-biopsy specimens (first-biopsy specimens, 21.4% +/- 20.3%; second-biopsy specimens, 9.6% +/- 11.7%; P < 0.01). The distribution of IgA mesangial deposits had diminished in most patients, and no IgA deposits were seen in second-biopsy specimens from 8 patients. These findings indicate that mesangial proliferation and interstitial changes in IgA nephropathy are reversible to a considerable extent. A histological cure may be obtainable in a considerable proportion of patients, especially if treatment is initiated at a relatively early stage. (C) 2002 by the National Kidney Foundation, Inc.