Primary glomerulonephritis: an update on renal survival and determinants of progression
Primary glomerulonephritis: an update on renal survival and determinants of progression
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DOI：
10.1093/qjmed/hcm142
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发表时间：
2008-03-01
影响因子：
13.3
通讯作者：
Stengel, B.
中科院分区：
文献类型：
--
作者：
Moranne, O.;Watier, L.;Stengel, B.
背景：自从血管紧张素转换酶抑制剂被广泛使用以来，很少有流行病学研究调查原发性肾小球肾炎(GN)及其决定因素的长期结局。目的：在一组原发性肾病患者中研究几种传统和非传统的肾脏疾病进展的危险因素。设计：回顾性队列研究。方法：我们纳入了1994-2001年间首次诊断的536例原发性GN患者：283例IgA肾病(IgA)，129例膜性肾病(MN)，124例局灶节段性肾小球硬化(FSGS)。结果：确诊时患者平均年龄为43+/-17岁，男性74例，平均估计肾小球滤过率(EGFR)为69+/-31mL/mN/1.73m。经过平均7年的随访，104名患者开始接受ESRD治疗，14名患者在到达ESRD之前死亡。FSGS组、MN组和IgAN组的7年肾存活率分别为69、88和82(p<；0.01)。在FSGS患者中，年龄越小，患ESRD的风险越高。基线蛋白尿、糖尿病和血红蛋白(Hb)浓度与ESRD的发生时间显著相关，与基线EGFR无关，但性别、高血压和吸烟与ESRD的发生时间无关。终末期肾病的调整后HR值糖尿病为2.6[95%可信区间，1.2-5.8]，最低为2.4[1.3-4.5]，中度Hb为1.9[1.0-3.6]，而最高为1.9[1.0-3.6]。讨论：在原发性GN患者中，FSGS的肾脏存活率明显低于IgAN和MN。进展的独立预测因素是所有GN类型的基线糖尿病和贫血以及蛋白尿，以及FSGS的较年轻年龄。
Background: Few epidemiological studies have investigated the long-term outcome of primary glomerulonephritis (GN) and its determinants in the decade since angiotensin-converting enzyme inhibitors entered widespread use.Aim: To study several traditional and less traditional risk factors for kidney disease progression in a cohort of patients with primary GN.Design: Retrospective cohort study.Methods: We included 536 patients with primary GN first diagnosed between 1994 and 2001: 283 IgA nephropathy (IgA), 129 membranous nephropathy (MN), and 124 focal and segmental glomerulosclerosis (FSGS). Adjusted hazard ratios (HR) or dialysis or preemptive transplantation for end-stage renal disease (ESRD) according to various characteristics were estimated with Cox proportional-hazard models.Results: At diagnosis, mean patient age was 43 +/- 17 years, 74 were men, and the mean estimated glomerular filtration rate (eGFR) was 69 +/- 31 mL/mn/1.73m(2). After a mean follow-up of 7-years, 104 patients had started ESRD treatment and 14 had died before reaching ESRD. The 7-year renal survival rate was 69 for FSGS, 88 for MN, and 82 for IgAN (p < 0.01). In patients with FSGS, younger age was associated with a higher risk of ESRD. Baseline proteinuria, diabetes, and haemoglobin (Hb) concentration were strongly associated with shorter time to ESRD independent of baseline eGFR, but gender, hypertension and smoking were not. Adjusted HRs for ESRD were 2.6 [95% confidence interval, 1.2-5.8] for diabetes and 2.4 [1.3-4.5] for the lowest and 1.9 [1.0-3.6] for the intermediate Hb tertiles versus the highest.Discussion: In patients with primary GN, renal survival is clearly lower for FSGS than for IgAN and MN. Independent predictors for progression were baseline diabetes and anaemia, as well as proteinuria, for all GN types, and younger age, for FSGS.