Prognosis in IgA nephropathy: 30-year analysis of 1,012 patients at a single center in Japan.
Prognosis in IgA nephropathy: 30-year analysis of 1,012 patients at a single center in Japan.
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DOI：
10.1371/journal.pone.0091756
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Nitta K
中科院分区：
文献类型：
--
作者：
Moriyama T;Tanaka K;Iwasaki C;Oshima Y;Ochi A;Kataoka H;Itabashi M;Takei T;Uchida K;Nitta K
IgA肾病（IgAN）患者的长期预后知之甚少。这项回顾性队列分析评估了自1974年以来我们中心诊断为IgAN的1，012名患者在肾活检时的临床和组织学结果、初始治疗、30年内的患者结局以及与进展相关的风险因素。在1，012名患者中，40.5%为男性。患者平均年龄为33 ± 12岁，平均血压为122 ± 17/75 ± 13 mmHg。平均血清肌酐浓度为0.89 ± 0.42 mg/dL，平均估计肾小球滤过率（eGFR）为78.5 ± 26.2 ml/min/1.73 m2。平均蛋白尿为1.19 ± 1.61 g/天，平均尿红细胞为36.6 ± 35.3/高倍视野。组织学上，47.6%的患者存在肾小球系膜细胞增生，44.3%存在内皮细胞增生，74.6%存在节段性硬化，28.8%存在肾小管萎缩/间质纤维化（牛津分类）。初始治疗包括26.9%的患者使用皮质类固醇，28.9%的患者使用肾素-血管紧张素-醛固酮系统抑制剂，11.7%的患者使用扁桃体切除术加类固醇。10年、20年和30年肾存活率分别为84.3%、66.6%和50.3%。扁桃体切除术加类固醇显著改善肾脏预后。考克斯多因素回归分析显示，肾活检时高蛋白尿、低eGFR和高尿酸是终末期肾病（ESRD）发生的独立危险因素。IgAN不是一种良性疾病，约50%的患者在30年内进展为ESRD。
Little is known about the long-term prognosis of patients with IgA nephropathy (IgAN). This retrospective cohort analysis evaluated clinical and histological findings at the time of renal biopsy, initial treatment, patient outcomes over 30 years, and risk factors associated with progression in 1,012 patients diagnosed with IgAN at our center since 1974. Of the 1,012 patients, 40.5% were male. Mean patient age was 33±12 years and mean blood pressure was 122±17/75±13 mmHg. Mean serum creatinine concentration was 0.89±0.42 mg/dL, and mean estimated glomerular filtration rate (eGFR) was 78.5±26.2 ml/min/1.73 m2. Mean proteinuria was 1.19±1.61 g/day, and mean urinary red blood cells were 36.6±35.3/high-powered field. Histologically, mesangial hypercellularity was present in 47.6% of patients, endothelial hypercellularity in 44.3%, segmental sclerosis in 74.6%, and tubular atrophy/interstitial fibrosis in 28.8% by Oxford classification. Initial treatment consisted of corticosteroids in 26.9% of patients, renin-angiotensin-aldosterone system inhibitor in 28.9%, and tonsillectomy plus steroids in 11.7%. The 10-, 20-, and 30-year renal survival rates were 84.3, 66.6, and 50.3%, respectively. Tonsillectomy plus steroids dramatically improved renal outcome. Cox multivariate regression analysis showed that higher proteinuria, lower eGFR, and higher uric acid at the time of renal biopsy were independent risk factors for the development of end stage renal disease (ESRD). IgAN is not a benign disease, with about 50% of patients progressing to ESRD within 30 years despite treatment.
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影响因子：
2.5
作者：
Ohno, I;Hosoya, T;Hikita, M
通讯作者：
Hikita, M
影响因子：
2
作者：
Ochi, Ayami;Moriyama, Takahito;Nitta, Kosaku
通讯作者：
Nitta, Kosaku
影响因子：
1.1
作者：
Cheng, Gen-yang;Liu, Dong-wei;Liu, Zhang-suo
通讯作者：
Liu, Zhang-suo
影响因子：
3.7
作者：
Lee H;Kim DK;Oh KH;Joo KW;Kim YS;Chae DW;Kim S;Chin HJ
通讯作者：
Chin HJ
影响因子：
13.2
作者：
Koyama, A;Igarashi, M;Kobayashi, M
通讯作者：
Kobayashi, M