Outcome study of renal biopsy patients in Okinawa, Japan
Outcome study of renal biopsy patients in Okinawa, Japan
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DOI：
10.1111/j.1523-1755.2004.00836.x
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发表时间：
2004-09-01
影响因子：
19.6
通讯作者：
Fukiyama, K
中科院分区：
文献类型：
--
作者：
Iseki, K;Miyasato, F;Fukiyama, K
在这里，我们报告了一项以社区为基础的流行病学研究，研究对象是1967年至1994年间在日本冲绳接受肾活检的患者。病例总数为2832例（男性1395例，女性1437例），活检时的平均（SD）年龄为30.0（10.0）岁（范围1.0 - 88.0岁）。肾活检最常见的临床指征是蛋白尿/血尿（46.7%）、肾病综合征（21.2%）、急性肾小球肾炎（10.1%）和系统性红斑狼疮（7.5%）。1985年至1994年期间接受肾活检的患者（N= 1480）发生急性肾小球肾炎的可能性远低于1967年至1984年期间接受治疗的患者（N= 1352）;蛋白尿/血尿、肾衰竭和糖尿病的发生率在后期略高。还对1971年至2000年期间开始透析的冲绳患者（N= 5246）进行了研究。其中，共有468名患者（260名男性和208名女性）在肾活检后开始透析。17年间终末期肾病（ESRD）的累积发生率为17%。这些患者中有一半在肾活检后5.8年内发展为ESRD。在透析患者中，慢性肾小球肾炎的活检率为12.6%，糖尿病为1.7%，肾硬化为2.6%，系统性红斑狼疮为52.1%。原发性肾脏疾病的诊断主要依靠临床。开始透析治疗后，肾活检患者的生存率略好于未活检患者，但这一发现无统计学意义（校正风险比0.855，95% CI 0.711-1.028，P= 0.095）。肾活检除了提供组织学证据外，其临床意义尚待证实。
Here we report a community-based epidemiologic study of patients who received renal biopsy in Okinawa, Japan between 1967 and 1994. The total number of cases was 2832 (1395 men and 1437 women), and the mean (SD) age at biopsy was 30.0 (10.0) years (range 1.0 to 88.0 years). The most common clinical indications for renal biopsy were proteinuria/hematuria (46.7%), nephrotic syndrome (21.2%), acute glomerulonephritis (10.1%), and systemic lupus erythematosus (7.5%). Patients who received renal biopsy between 1985 and 1994 (N= 1480) were much less likely to have acute glomerulonephritis than patients treated between 1967 and 1984 (N= 1352); the rates of proteinuria/hematuria, renal failure, and diabetes mellitus were slightly higher in the later period. Okinawa patients who began dialysis between 1971 and 2000 (N= 5246) were also studied. Among them, a total of 468 patients (260 men and 208 women) began dialysis after renal biopsy. The cmulative incidence of end-stage renal disease (ESRD) among these patients was 17% in 17 years. Half of these patients developed ESRD in the 5.8 years after renal biopsy. Among the dialysis patients, the biopsy rate was 12.6% in chronic glomerulonephritis, 1.7% in diabetes mellitus, 2.6% in nephrosclerosis, and 52.1% in systemic lupus erythematosus. The diagnoses of primary renal diseases were primarily made clinically. The survival rate after starting dialysis therapy was slightly better in those with than in those without renal biopsy but this finding was not statistically significant (adjusted hazards ratio 0.855, 95% CI 0.711-1.028, P= 0.095). The clinical significance of renal biopsy, other than its provision of histologic evidence, remains to be shown.