IGA NEPHROPATHY - PROGNOSTIC-SIGNIFICANCE OF PROTEINURIA AND HISTOLOGICAL ALTERATIONS
IGA NEPHROPATHY - PROGNOSTIC-SIGNIFICANCE OF PROTEINURIA AND HISTOLOGICAL ALTERATIONS
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DOI：
10.1159/000183000
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发表时间：
1983-01-01
期刊：
影响因子：
2.5
通讯作者：
SHIGEMATSU, H
中科院分区：
文献类型：
--
作者：
KOBAYASHI, Y;TATENO, S;SHIGEMATSU, H
对166例IgA肾病患者进行了回顾性研究，以阐明临床和组织学特征与疾病严重程度和预后之间的可能相关性。活检时发现61例肾功能受损，内生肌酐清除量(Ccr)低于90ml/min。在最终检查时，经过平均34个月的随访期，82名患者肾功能受损，其中12名患者进入终末期肾功能衰竭需要血液透析治疗。每天尿蛋白1.0g与肾功能损害密切相关，无论是在活组织检查时还是在最后观察时。如果存在高血压，预计也会出现不利的结果。微量血尿、大量血尿或高血清IgA水平似乎与预后无关。组织学上，肾功能受损的患者以系膜或球部硬化、间质纤维化、肾小管萎缩等硬化性病变和系膜细胞增多、绒毛粘连等活动性改变更为常见和严重。在这些患者中，IgA和[补体成分]C3在系膜和毛细血管环中的定位更令人印象深刻。约半数患者的IgA肾病可能进展缓慢，明显的蛋白尿和严重的组织学改变似乎与不利的病程密切相关。
Patients (166) with IgA nephropathy were studied retrospectively to clarify possible correlations between clinical and histological features, and the severity and prognosis of the disease. At the time of biopsy, impaired renal function, with creatinine clearance (Ccr) below 90 ml/min was found in 61 cases. At the final examination, after a mean follow-up period of 34 mo., 82 patients had impaired renal function, 12 of these patients went into terminal renal failure requiring hemodialysis treatment. The presence of proteinuria of > 1.0 g/day was closely correlated with impairment of renal function both at the time of biopsy and at the final observation. An unfavorable outcome was also anticipated in the presence of hypertension. Microhematuria, macrohematuria or high serum IgA levels did not appear to be related to the outcome. Histologically, sclerotic lesions such as mesangial or global sclerosis, interstitial fibrosis and tubular atrophy, and some active changes such as mesangial hypercellularity and tuft adhesion were more frequent and severe in patients with impaired renal function. Impressive localization of IgA and [complement component] C3 in the mesangium as well as in capillary loops was observed more often in these patients. IgA nephropathy may follow a slowly progressive course in about half of the patients, and marked proteinuria and severe histological changes appear to correlate closely with an unfavorable course.