Extracapillary proliferation and arteriolar hyalinosis are associated with long-term kidney survival in IgA nephropathy
Extracapillary proliferation and arteriolar hyalinosis are associated with long-term kidney survival in IgA nephropathy
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DOI：
10.1007/s10157-015-1185-0
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发表时间：
2016-08-01
影响因子：
2.3
通讯作者：
Narita, Ichiei
中科院分区：
文献类型：
--
作者：
Kaneko, Yoshikatsu;Yoshita, Kazuhiro;Narita, Ichiei
IgA肾病的牛津分类包括四个作为预后指标的标记物。我们回顾性研究了包括细胞和纤维细胞新月形增生（Ex）和小动脉透明质病(A)在内的毛细血管外增生与肾功能长期预后的相关性。本研究共纳入了314名确诊为IgA肾病的日本患者，随访时间为12个月及以上。共有186例患者服用UP，剂量为0.5 g/d。排除糖尿病或严重肾损伤患者（eGFR < 30 ml/min/1.73 m(2)）。每个病变不存在时，Ex和A的得分为0，存在时，得分为1。终点确定为初始eGFR降低50%或终末期肾病（定义为eGFR < 15 ml/min/1.73 m）(2)。在单因素分析中，Ex1和A1患者的肾脏存活率显著降低，如果UP剂量为0.5 g/天。在UP < 0.5/天的患者中，没有任何临床和病理参数被确定为危险因素。在包含病理参数的多变量模型中，如果UP剂量为0.5 g/d， Ex1和A1是肾脏结局的独立危险因素。在接受ras受体阻滞剂治疗或在引入甲基强的松龙脉冲治疗之前接受治疗的患者中，Ex是唯一的独立危险因素。在包括临床参数在内的多因素分析中，eGFR单独是一个危险因素，与其他参数有很强的相关性。Ex和A与UP患者肾脏预后相关，剂量为0.5 g/d。
The Oxford classification of IgA nephropathy consists of four markers as prognosticators. We retrospectively examined the relevance of extracapillary proliferation involving cellular and fibrocellular crescents (Ex) and arteriolar hyalinosis (A) on the long-term outcome of renal function.A total of 314 Japanese patients who were diagnosed with IgA nephropathy, with 12 months or more of follow-up period were included in this study. A total of 186 patients were with UP aeyen 0.5 g/day. Patients with diabetes mellitus or severe kidney injury (eGFR < 30 ml/min/1.73 m(2)) were excluded. The presence of Ex and A were scored 0 in the absence, and 1 in the presence, of each lesion. The end point was determined as a 50 % reduction in initial eGFR or end-stage renal disease defined as eGFR < 15 ml/min/1.73 m(2).In univariate analyses, the kidney survival rate was significantly lower in patients with Ex1 and A1 if UP aeyen 0.5 g/day. In the patients with UP < 0.5/day, none of the clinical and pathological parameters was determined as a risk factor. In the multivariate model including pathological parameters, Ex1 and A1 were independent risk factors for renal outcome if UP aeyen 0.5 g/day. In those patients treated with RAS-blocker or treated before introduction of methylprednisolone pulse therapy, Ex was the only independent risk factor. In multivariate analysis including clinical parameters, eGFR alone was a risk factor, due to strong correlation with other parameters.Ex and A would be associated with the renal outcome of the patients with UP aeyen 0.5 g/day.