Prognosis after a complete remission in adult patients with idiopathic membranous nephropathy
Prognosis after a complete remission in adult patients with idiopathic membranous nephropathy
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DOI：
10.1016/s0272-6386(99)70138-1
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发表时间：
1999-06-01
影响因子：
13.2
通讯作者：
Cattran, DC
中科院分区：
文献类型：
--
作者：
Laluck, BJ;Cattran, DC
本研究回顾了82例经活检证实的特发性膜性肾小球肾炎（IMGN）成人患者在蛋白尿完全缓解后的长期结局，占我们登记研究中IMGN总病例的25%（323例中的82例）。完全缓解定义为至少连续两次随访评估显示蛋白尿0.3g/d或更少的蛋白。缓解前，70%的患者有肾病范围的蛋白尿（就诊时61%，随访期间9%），30%始终为亚肾病平均总观察时间为101 ± 56个月，缓解后时间为69 ± 60个月。71%的患者保持缓解，29%复发。在复发组中，46%复发至肾病范围蛋白尿，54%复发至亚肾病水平。86%的患者（82例患者中的71例）的血浆肌酐水平保持稳定，但在其余14%的患者（82例患者中的8例）中，尽管有一段时间的完全缓解，血浆肌酐水平仍升高或保持升高。没有患者继续发展为终末期肾病。77%的患者在缓解后6个月内没有接受过特异性治疗，而23%的患者接受了单独的类固醇治疗或与免疫抑制剂联合治疗。在多变量分析中，有利于缓解及其持久性的因素是持续较低水平的蛋白尿和女性。完全缓解表明IMGN患者的长期预后良好，但复发是常见的，并且在一小部分患者中发生慢性肾功能不全。因此，我们的数据表明，即使是这组患者也应该定期监测。(C)1999年由国家肾脏基金会，公司。
This review of the long-term outcome after a complete remission of proteinuria includes 82 adult patients with biopsy-proven idiopathic membranous glomerulonephritis (IMGN), who represented 25% of the total cases (82 of 323 cases) of IMGN in our registry. Complete remission was defined as at least two consecutive follow-up evaluations showing proteinuria of 0.3 g/d or less of protein, Before remission, 70% of the patients had nephrotic-range proteinuria (61% at presentation, 9% during follow-up), and 30% were always subnephrotic (protein level < 3.5 g/d), Mean total observation time was 101 +/- 56 months, with a postremission period of 69 +/- 60 months. Seventy-one percent of the patients remained in remission and 29% relapsed. In the relapse group, 46% relapsed to nephrotic-range proteinuria and 54% relapsed to subnephrotic levels. The plasma creatinine level remained stable in 86% of the patients (71 of 82 patients) but became or remained elevated despite a period of complete remission in the remaining 14% (8 of 82 patients). No patient went on to end-stage renal disease. Seventy-seven percent of the patients had no specific treatment within 6 months of remission, whereas 23% had steroid therapy alone or in combination with an immunosuppressive agent. In a multivariate analysis, the factors that favored both remission and its durability were persistent lower levels of proteinuria and female sex. Complete remission indicates an excellent long-term prognosis in patients with IMGN, but relapses are common and, in a small percentage, chronic renal insufficiency occurs. Thus, our data suggest that even this group of patients should be monitored on a regular basis. (C) 1999 by the National Kidney Foundation, Inc.