Long-term outcome of IgA nephropathy with minimal change disease: a comparison between patients with and without minimal change disease
Long-term outcome of IgA nephropathy with minimal change disease: a comparison between patients with and without minimal change disease
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DOI：
10.1007/s40620-015-0242-9
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发表时间：
2016-08-01
影响因子：
3.4
通讯作者：
Liu, Zhi-Hong
中科院分区：
文献类型：
--
作者：
Li, Xiao-Wei;Liang, Shao-Shan;Liu, Zhi-Hong
背景免疫球蛋白(Ig)A肾病伴微小病变者(MCD-IgAN)的临床病理特征、治疗反应及远期转归尚未明确。方法对金陵医院IgA肾病登记处收治的经活检证实的MCD-IgAN患者与无微小病变者(Non-MCD-IgAN)进行比较。结果247例MCD-IgAN患者与1,121例非MCD-IgAN患者的临床资料进行比较。与非MCD-IgAN患者相比，MCD-IgAN患者年龄更小，以男性为主，尿蛋白、总胆固醇和估计肾小球滤过率(EGFR)较高，高血压和微量血尿发生率较低，血肌酐水平较低，肾小球、肾小管间质和血管病变较轻。在非MCD-IgAN组中，157例(14.0%)患者达到肾脏终点，103例(9.2%)患者进入终末期肾病(ESRD)。按Kaplan-Meier法计算，ESRD患者的5、10、15和20年累积肾存活率分别为95.0%、83.0%、72.9%和65.4%。在MCD-IgAN组中，没有患者进入终末期肾病，只有4例(1.6%)达到了肾终点。MCD-IgAN患者的肾脏预后明显好于非MCD-IgAN患者(p<；0.01)。多因素COX分析显示，蛋白尿1.0g/天、高血压、表皮生长因子受体、60ml/分钟/1.73m(2)、低蛋白血症和高尿酸血症是非MCD-IgAN患者肾脏存活的独立危险因素[危险比(HR)3.43，p<；0.001；HR1.65，p<；0.05；HR2.61，p<；0.001；HR2.40，p<；0.001；HR 2.27，p<；0.001；0.001)，但不适用于MCD-IgAN。结论MCD-IgAN患者的远期预后明显优于非MCD-IgAN患者。
Background The clinicopathological characteristics, treatment response and long-term outcome of immunoglobulin (Ig)A nephropathy with minimal change disease (MCD-IgAN) are not well defined.Methods Patients with biopsy-proven MCD-IgAN from the Jinling Hospital IgA nephropathy Registry were systematically reviewed and compared with those with IgA nephropathy without minimal change disease (Non-MCD-IgAN).Results We compared data of 247 MCD-IgAN patients and 1,121 Non-MCD-IgAN patients. Compared to Non-MCD-IgAN, MCD-IgAN patients were younger,with male predominance, had higher levels of proteinuria, total cholesterol and estimated glomerular filtration rate (eGFR), lower incidence of hypertension and microhematuria, lower level of serum creatinine, and had less severe glomerular, tubulointerstitial and vascular lesions in renal pathology. In the Non-MCD-IgAN group, 157 patients (14.0 %) reached the renal endpoint and 103 patients (9.2 %) entered end-stage renal disease (ESRD). The 5-,10-, 15- and 20-year cumulative renal survival rates from ESRD, calculated by Kaplan-Meier method, were 95.0, 83.0, 72.9 and 65.4 %, respectively. In the MCD-IgAN group, no patients entered ESRD and only 4 (1.6 %) reached the renal endpoint. Patients with MCD-IgAN had a significantly better renal outcome than Non-MCD-IgAN (p < 0.01). At multivariate Cox analysis, proteinuria > 1.0 g/day, hypertension, eGFR < 60 ml/min/1.73 m(2), hypoproteinemia and hyperuricemia were independent risk factors of renal survival for Non-MCD-IgAN patients [hazard ratio (HR) 3.43, p < 0.001; HR 1.65, p < 0.05; HR 2.61, p < 0.001; HR 2.40, p < 0.001; HR 2.27, p < 0.001, respectively), but not for patients with MCD-IgAN.Conclusions The long-term outcome of patients with MCD-IgAN is significantly better than that of patients with Non-MCD-IgAN.