Spontaneous remission of nephrotic syndrome in patients with IgA nephropathy
Spontaneous remission of nephrotic syndrome in patients with IgA nephropathy
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DOI：
10.1093/ndt/gfq559
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发表时间：
2011-05-01
影响因子：
6.1
通讯作者：
Kang, Shin-Wook
中科院分区：
文献类型：
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作者：
Han, Seung Hyeok;Kang, Ea Wha;Kang, Shin-Wook
背景伊加肾病（IgAN）可并发肾病综合征。由于自发性重蛋白尿的解决是罕见的，皮质类固醇治疗应考虑在这种情况下，特别是当IgAN合并微小病变的疾病。在这里，我们报告我们的经验，自发缓解肾病综合征患者IgAN和长期的结果，这些患者。2001年1月至2009年3月期间，233例经活检证实的IgAN患者入组。根据病历回顾性收集人口统计学、临床和实验室数据。此外，还对肾小球和肾小管间质病变的病理结果进行了审查。记录完全或部分缓解、自发缓解、复发、肾功能恶化和终末期肾病的结局数据。24例患者（10.3%）表现为肾病综合征。其中，5例患者在肾病综合征出现后6个月内自行缓解。有趣的是，自发缓解甚至发生在两名患者血清肌酐水平升高和晚期肾损害。随访期间无复发或复发，无患者肾功能进行性恶化。这项研究表明，肾病综合征的自发缓解可能发生在IgAN的任何阶段，并具有良好的长期预后，不会复发。考虑到可能存在漏报病例，需要进行大规模研究，并应密切关注此类复杂病例。
Background. IgA nephropathy (IgAN) can be complicated by nephrotic syndrome. Because the spontaneous resolution of heavy proteinuria is rare, corticosteroid therapy should be considered in such cases, particularly when IgAN is combined with minimal-change disease. Here, we report our experience of spontaneous remission of nephrotic syndrome in patients with IgAN and the long-term outcomes of these patients.Methods. Two hundred and thirty-three patients with biopsy-proven IgAN were enrolled between January 2001 and March 2009. Demographic, clinical and laboratory data were collected retrospectively based on medical records. In addition, pathologic findings were reviewed for glomerular and tubulointerstitial lesions. Outcome data for complete or partial remission, spontaneous remission, relapse, deterioration of renal function, and end-stage renal disease were recorded.Results. Twenty-four patients (10.3%) presented nephrotic syndrome. Among them, five patients underwent spontaneous remission within 6 months after the presentation of nephrotic syndrome. Interestingly, spontaneous remission occurred even in two patients who had elevated serum creatinine levels and advanced renal damage. During follow-up, neither recurrence nor relapse occurred, and no patients showed progressive deterioration of kidney function.Conclusions. This study suggests that spontaneous remission of nephrotic syndrome may occur in any stage of IgAN and carries a favourable long-termoutcome without relapse. Given the possibility of under-reported cases, large-scale studies are required, and careful attention should be paid to such complicated cases.