Prognostic indicators of IgA nephropathy in the Chinese - clinical and pathological perspectives
Prognostic indicators of IgA nephropathy in the Chinese - clinical and pathological perspectives
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DOI：
10.1093/ndt/17.1.64
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发表时间：
2002-01-01
影响因子：
6.1
通讯作者：
Lai, FMM
中科院分区：
文献类型：
--
作者：
Li, PKT;Ho, KKL;Lai, FMM
背景伊加肾病是世界上最常见的原发性肾小球肾炎。高达30%的患者可在10年内进展为终末期肾病（ESRD）。我们研究了168例伊加肾病患者，平均随访7.4年，并试图确定与疾病预后相关的临床和病理数据。在肾活检时的临床特征进行了审查。组织学受累程度半定量评分为1- 3级。在我们的患者队列中女性占优势（男性：女性比例为1：1.5）。活检时的平均年龄为32.9 ± 10.0岁。168例患者中47例（28.0%）有高血压，136例患者中47例（34.6%）有高血压家族史。伊加肾病的高组织学分级与高血压、高血压家族史、较高的血清肌酐、总胆固醇和24小时尿蛋白排泄以及较低的血清白蛋白水平相关。在随访期间，4例患者死亡，另有24例进展为ESRD。1年、5年和10年肾存活率分别为92.0%、87.5%和81.8%。单因素分析显示，高血压、高血压家族史、肾功能损害（血肌酐>120 mumol/l）、高胆固醇、蛋白尿>1 g/d和高组织学分级与不良预后相关。多因素分析显示，高血压、高血压家族史、肾功能损害、蛋白尿> 1g/d和组织学分级是肾存活率的独立预测因素。高血压患者发生肾功能衰竭的相对危险度为9.60（95%可信区间4.02 ~ 22.92），高血压家族史患者为1.56（1.16-2.02），肾功能损害患者为15.38（6.40-36.93），组织学分级每增加1级，肾功能衰竭的相对危险度为5.93（3.07-11.46）。与女性患者相比，男性患者并未显示出更多的不良结局。我们的研究结果表明，肾活检仍然是有用的，即使在临床上微不足道的疾病，因为它的独特价值的预后和危险分层。中国伊加肾病患者的长期预后值得警惕。高血压家族史对预后的重要性尚未被广泛认识，需要进一步研究。
Background. IgA nephropathy is the most common primary glomerulonephritis in the world. Up to 30% of patients can progress to end-stage renal disease (ESRD) in 10 years.Methods. We studied 168 Chinese patients with IgA nephropathy followed for an average of 7.4 years in our hospital and tried to identify the clinical and pathological data that were associated with the prognosis of the disease. Clinical features at the time of renal biopsy were reviewed. Severity of histological involvement was scored semi-quantitatively as grade 1-3.Results. There was a female preponderance in our cohort of patients (male: female ratio 1 : 1.5). The average age at biopsy was 32.9 +/- 10.0 years. Forty-seven of the 168 patients (28.0%) were hypertensive and 47 of 136 patients (34.6%) had a family history of hypertension. A high histological grade of IgA nephropathy was associated with hypertension at presentation, family history of hypertension, a higher serum creatinine, total cholesterol and 24-h urine protein excretion, and a lower serum albumin level. During the follow-up period, four patients died and another 24 progressed to ESRD. The renal survival was 92.0% at 1 year, 87.5% at 5 years and 81.8% at 10 years. With univariate analysis, hypertension at presentation, family history of hypertension, renal impairment at presentation (plasma creatinine >120 mumol/l), high cholesterol, proteinuria >1 g/day and high histological grading were associated with poor prognosis. With multivariate analysis, hypertension at presentation, family history of hypertension, renal impairment at presentation, proteinuria >1 g day and histological grading were independent predictors of renal survival. The relative risks of renal failure for patients were 9.60 (95% confidence interval 4.02 22.92) with hypertension, 1.56 (1.16-2.02) with a family history of hypertension, 15.38 (6.40-36.93) with renal impairment and 5.93 (3.07-11.46) with every increase of one histological grade. Male patients did not show a more adverse outcome compared with females.Conclusions. Our results Suggest that renal biopsy remains useful, even in clinically trivial disease, because of its distinct Value in prognosis and risk stratification. The long-term prognosis of IgA nephropathy in Chinese patients is guarded. The prognostic importance of family history of hypertension has not been widely recognized and requires further study.