Natural history and risk factors for immunoglobulin A nephropathy in Japan
Natural history and risk factors for immunoglobulin A nephropathy in Japan
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DOI：
10.1016/s0272-6386(97)90333-4
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发表时间：
1997-04-01
影响因子：
13.2
通讯作者：
Kobayashi, M
中科院分区：
文献类型：
--
作者：
Koyama, A;Igarashi, M;Kobayashi, M
进行性肾病研究小组于1985年和1993年在日本对原发性肾小球肾炎（GN）病例进行了一项全国性调查。本文报道的调查结果显示，免疫球蛋白A肾病（IgAN）的患病率很高，预后相对较差。使用免疫荧光显微镜，1,063例患者中有47.2%被诊断为IgAN; 62.8%的患者有弥漫性系膜增生性GN，23.0%观察到局灶性系膜增生性GN。近70%的患者无临床症状，常规体检发现IgAN。平均观察期为11.8 +/- 6.3年。502例IgAN患者的肾存活率（以透析开始和肾相关死亡为终点）分别为96%、85%、75%和61%（从检测到最早的已知肾脏异常开始算起）。弥漫性系膜增生性肾炎患者5、10、15和20年的肾存活率分别为96%、83%、75%和59%。在观察期结束时，20%的患者改善，45.8%的患者无变化，13.5%的患者恶化，20.4%的患者发生肾相关死亡。Logistic多变量分析显示肾功能衰竭的危险因素为活检时确定的血清肌酐浓度大于或等于1.4 mg/ dL（相对风险，3.5）和尿蛋白水平大于或等于+（试纸）（相对风险，6.4）。这些参数可用于评估这种疾病的相对晚期阶段的预后。值得注意的是，即使组织学检查结果仅包括轻微的肾小球异常或局灶性增生性改变，仍有相对较高比例的IgAN患者进展为终末期肾衰竭。(C)1997年由国家肾脏基金会，公司。
The Research Group on Progressive Renal Diseases conducted a national survey, in Japan, of cases of primary glomerulonephritis (GN) in 1985 and 1993. The results of the survey, reported here, revealed a high prevalence and relatively poor prognosis for immunoglobulin A nephropathy (IgAN). Using immunofluorescent microscopy, 47.2% of 1,063 patients were diagnosed as having IgAN; 62.8% of patients had diffuse mesangial proliferative GN, and focal mesangial proliferative GN was observed in 23.0%. Nearly 70% of the patients had no clinical symptoms, and the IgAN was detected by routine physical examination. The mean period of observation was 11.8 +/- 6.3 years. Renal survival rates for the 502 cases of IgAN, in which the start of dialysis and renal-related death were end points, were 96%, 85%, 75%, and 61% at 5, 10, 15, and 20 years, respectively, from the time of the detection of the earliest known renal abnormalities. Renal survival rates of patients with diffuse mesangial proliferative GN were 96%, 83%, 75%, and 59% at 5, 10, 15, and 20 years, respectively. At the end of the observation period, 20% of patients had improved, 45.8% showed no change, 13.5% had deteriorated, and 20.4% had renal-related death. The risk factors for renal failure by logistic multivariate analysis were serum creatinine concentration greater than or equal to 1.4 mg/ dL (relative risk, 3.5) and levels of urinary protein greater than or equal to+(dipstick) (relative risk, 6.4), determined at the time of biopsy. These parameters can be useful for assessing prognosis during the relatively advanced stages of this disease. It is important to note that a relatively high percentage of patients with IgAN progressed to end-stage renal failure even when their histologic findings comprised only minor glomerular abnormalities or focal proliferative changes. (C) 1997 by the National Kidney Foundation, Inc.