A tricontinental view of IgA nephropathy
A tricontinental view of IgA nephropathy
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DOI：
10.1093/ndt/gfg207
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发表时间：
2003-08-01
影响因子：
6.1
通讯作者：
Cattran, DC
中科院分区：
文献类型：
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作者：
Geddes, CC;Rauta, V;Cattran, DC
背景这项回顾性研究的目的是分析来自三大洲四个中心的患者，以确定伊加肾病（IgAN）长期结局的差异是否可以通过临床和实验室特征来解释。该研究包括来自英国格拉斯哥（n = 112）、芬兰赫尔辛基（n=204）、澳大利亚悉尼（n=121）和加拿大多伦多（n = 274）的711名经活检证实的IgAN成人。从提交给肾病科医生时收集的数据包括年龄、性别、24小时尿蛋白排泄量（UP 0）、平均动脉压（MAP（0））和肌酐清除率（CrCl 0）。结果：肌酐清除率（CrCl）斜率和肾存活率。在就诊时，基线临床特征存在显著差异，来自赫尔辛基的患者具有最低的中位UP 0、最低的MAPO和最高的CrCl 0，所有这些均表明疾病较轻。不同中心之间的肾存活率存在显著差异，赫尔辛基、悉尼、格拉斯哥和多伦多的10年精算存活率分别为95.7、87.0、63.9和61.6%（P < 0.0001;对数秩）。考克斯比例风险模型显示，较低的年龄（0）和较低的CrCl 0是肾存活率降低的重要独立预测因素。此外，来自赫尔辛基和悉尼但非格拉斯哥的患者的肾存活率显著长于来自多伦多的患者。CrCl的中位斜率因地区而异，从赫尔辛基的-1.24 ml/min/年到多伦多的-3.99 ml/min/年（Kruskal-Wallis H检验P < 0.0001）。通过多变量分析，年龄较大（0），较高的CrCl 0和较低的UP 0与进展较慢独立相关。来自赫尔辛基的受试者的恶化速度显著较慢，与就诊时的其他临床参数无关。当269名患者出现CrCl 0
Background. The purpose of this retrospective study was to analyse patients from four centres in three continents to determine if differences in long-term outcome of IgA nephropathy (IgAN) are explained by clinical and laboratory features at presentation.Methods. The study included 711 adults with biopsy-proven IgAN from Glasgow, UK (n = 112), Helsinki, Finland (n=204), Sydney, Australia (n=121) and Toronto, Canada (n = 274). Data collected from time of presentation to a nephrologist were age, gender, 24-h urine protein excretion (UP0),mean arterial pressure (MAP(0)) and creatinine clearance (CrCl0). Outcomes were slope of creatinine clearance (CrCl) and renal survival.Results. At presentation there was significant variability in baseline clinical features with patients from Helsinki having the lowest median UP0, lowest MAPO and highest CrCl0, all suggesting milder disease. There was significant variability in renal survival between centres with 10-year actuarial survival of 95.7 87.0, 63.9 and 61.6% in Helsinki, Sydney, Glasgow and Toronto, respectively (P < 0.0001; log rank). Cox proportional hazards model revealed lower age(0) and lower CrCl0 were significant independent predictors of reduced renal survival. In addition, patients from Helsinki and Sydney but not Glasgow had significantly longer renal survival than patients from Toronto. Median slope of CrCl varied by region from -1.24ml/min/year in Helsinki, to -3.99ml/min/ year in Toronto (Kruskal-Wallis H test P < 0.0001). By multivariate analysis older age(0), higher CrCl0 and lower UP0 were independently associated with slower progression. Subjects from Helsinki had a significantly slower deterioration independent of the other clinical parameters at presentation. When the 269 patients presenting with CrCl0