Microangiopathic Lesions in IgA Nephropathy: A Cohort Study
Microangiopathic Lesions in IgA Nephropathy: A Cohort Study
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IgA 肾病的微血管病变：一项队列研究
DOI：
10.1053/j.ajkd.2019.03.416
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发表时间：
2019-11-01
影响因子：
13.2
通讯作者：
Zhang, Hong
中科院分区：
文献类型：
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作者：
Cai, Qingqing;Shi, Sufang;Zhang, Hong
理由与目的：免疫球蛋白A肾病（IgAN）可发生肾小动脉微血管病变，但其在疾病进展中的作用尚不清楚。我们试图了解IgAN中微血管病变的患病率和特征及其在疾病进展中的作用。研究设计：回顾性队列研究。背景和参与者：在这项研究中，我们招募了一个中国队列，944名成年IgAN患者随访至少1年。预测因素：肾小动脉微血管病变。结果：复合肾脏终点事件定义为肾小球滤过率降低50%、终末期肾病或死亡。分析方法：所有肾活检均由2名研究人员独立审查。光镜下检测肾小动脉微血管病变。采用多变量Cox回归分析来检验微血管病变与预后之间的关系。结果：总体而言，194例（20.6%）患者有肾小动脉微血管病变。与没有微血管病变的患者相比，有微血管病变的患者血压更高，蛋白尿更严重，肾小球滤过率估计更低（均P < 0.001）。中位随访4.2年后，75例（38.7%）微血管病变患者和83例（11.1%）无微血管病变患者达到复合肾脏终点（P < 0.001）。在调整活检时可用的临床和病理变量的多变量Cox回归模型中，微血管病变的存在是肾衰竭的独立危险因素（HR, 1.95; 95% CI, 1.34-2.83; P < 0.001）。肾血管硬化（动脉内膜纤维化或小动脉透明质病）不是肾脏疾病进展的危险因素（P = 0.5）。局限性：一个单一的中国中心的经验，回顾性研究，大多数患者没有检测溶血标志物（例如，触珠蛋白水平，乳酸脱氢酶水平和血吸虫细胞）。结论：肾小动脉微血管病变在IgAN中很常见，它们的存在与肾衰竭的进展独立相关。如果在其他患者队列中得到证实，则可以考虑将此类病变纳入IgAN的正式分类方案。
Rationale & Objective: Renal arteriolar microangiopathic lesions may occur in immunoglobulin A nephropathy (IgAN), but their role in disease progression remains unclear. We sought to understand the prevalence and character of microangiopathic lesions in IgAN and their role in disease progression.Study Design: A retrospective cohort study.Setting & Participants: In this study, we enrolled a Chinese cohort with 944 adult patients with IgAN who had been followed up for at least 1 year.Predictors: Renal arteriolar microangiopathic lesions.Outcomes: Composite kidney end point event defined as a >50% reduction in estimated glomerular filtration rate, end-stage kidney disease, or death.Analytical Approach: All kidney biopsies were independently reviewed by 2 investigators. Renal arteriolar microangiopathic lesions were detected using light microscopy. Multivariable Cox regression analysis was used to test the association between microangiopathic lesions and the outcomes.Results: Overall, 194 (20.6%) patients had renal arteriolar microangiopathic lesions. Patients with microangiopathic lesions presented with higher blood pressures, more severe proteinuria, and lower estimated glomerular filtration rates (all P < 0.001) than patients without microangiopathic lesions. After a median follow-up of 4.2 years, 75 (38.7%) patients with microangiopathic lesions and 83 (11.1%) patients without these lesions reached the composite kidney end point (P < 0.001). In a multivariable Cox regression model adjusting for clinical and pathologic variables available at the time of biopsy, the presence of microangiopathic lesions was an independent risk factor for kidney failure (HR, 1.95; 95% CI, 1.34-2.83; P < 0.001). Renal vascular sclerosis (arterial intimal fibrosis or arteriolar hyalinosis) was not a risk factor for kidney disease progression (P = 0.5).Limitations: A single Chinese center's experience, retrospective study, most patients were not tested for hemolytic markers (for example, haptoglobin level, lactate dehydrogenase level, and schistocytes).Conclusions: Renal arteriolar microangiopathic lesions are frequent in IgAN and their presence is independently associated with progression to kidney failure. If confirmed in other patient cohorts, such lesions could be considered for inclusion in formal classification schemes of IgAN.