A novel simpler histological classification for renal survival in IgA nephropathy: A retrospective study
A novel simpler histological classification for renal survival in IgA nephropathy: A retrospective study
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DOI：
10.1053/j.ajkd.2007.03.013
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发表时间：
2007-06-01
影响因子：
13.2
通讯作者：
Schena, Francesco P.
中科院分区：
文献类型：
--
作者：
Manno, Carlo;Strippoli, Giovanni F. M.;Schena, Francesco P.
背景：免疫球蛋白A （IgA）肾病患者可能在肾活检后10 - 20年内进展为终末期肾病（ESRD）。我们通过使用一种新的简化的组织学分类来评估与肾脏长期生存相关的因素。研究设计：回顾性研究。环境和参与者：1971年1月至2006年12月在我们的单一中心就诊的IgA肾病患者437例（男性296例，女性141例）。大多数患者接受肾素-血管紧张素系统抑制剂治疗。预测因素：基线年龄、性别、是否存在血尿、是否存在高血压、血清肌酐水平、基线尿蛋白和2种组织学分类。结果和测量方法：采用单因素和多因素分析，采用log-rank检验和Cox比例风险法评估基线因素与ESRD时间的关系。结果：平均随访107.6个月，共发生ESRD事件72例。肾活检后5年、10年、15年和20年生存率分别为94.1%、82.1%、73.1%和60.3%。ESRD风险增加的独立基线预测因子为微血尿且无复发性大血尿（校正危险比[HR]， 2.18； 95%可信区间[Cl]， 1.30 ~ 3.65; P = 0.003）、血清肌酐水平升高1.0 mg/dL (88.4 mu mol/L) （HR, 1.50; 95% Cl, 1 A 0 ~ 2.07; P = 0.013）、蛋白尿中蛋白含量升高1.0 g/dL (10.0 g/L) （HR, 1.28; 95% Cl, 1.07 ~ 1.52; P = 0.006）以及组织学病变分级。根据我们的3级分类，每增加1级，ESRD风险增加近6倍（调整后危险度，5.95;95% Cl， 3.54至10.01;P < 0.0001）。局限性：缺乏对研究期间可能发生的治疗变化的调整。结论：IgA肾病患者的肾损害进展与临床发病时显微镜下血尿、血清肌酐水平升高、蛋白尿升高和组织学病变分级有关。我们的分类系统似乎比其他分类更简单，并且与ESRD风险相关，这可以帮助识别个体高危患者，并将随机临床试验中的患者分层为均匀组。
Background: Patients with immunoglobulin A (IgA) nephropathy may progress to end-stage renal disease (ESRD) within 10 to 20 years after renal biopsy. We evaluated factors associated with long-term renal survival by using a novel simplified histological classification.Study Design: Retrospective study.Setting & Participants: 437 patients (296 men, 141 women) with IgA nephropathy seen at our single center from January 1971 to December 2006. Most patients received treatment with renin-angiotensin system inhibitors.Predictors: Baseline age, sex, presence of hematuria, presence of hypertension, serum creatinine level, urine protein at baseline, and 2 histological classifications.Outcomes & Measurements: Relationship of baseline factors to time to ESRD was evaluated by means of univariate and multivariate analysis with log-rank test and the Cox proportional hazard method.Results: In a mean follow-up of 107.6 months, 72 ESRD events occurred. The 5-, 10-, 15-, and 20-year renal survival rates after renal biopsy were 94.1%, 82.1%, 73.1%, and 60.3%, respectively. Independent baseline predictors of increased ESRD risk were microhematuria with absence of recurrent macrohematuria (adjusted hazard ratio [HR], 2.18; 95% confidence interval [Cl], 1.30 to 3.65; P = 0.003), 1.0 mg/dL (88.4 mu mol/L) higher serum creatinine level (HR, 1.50; 95% Cl, 1 A 0 to 2.07; P = 0.013), proteinuria with 1.0 g/dL (10.0 g/L) greater protein (HR, 1.28; 95% Cl, 1.07 to 1.52; P = 0.006), and grading of histological lesions. A 1-grade increase according to our 3-grade classification was associated with a nearly 6-fold ESRD risk increase (adjusted HR, 5.95; 95% Cl, 3.54 to 10.01; P < 0.0001).Limitations: Lack of adjustment for changes in treatment that may have occurred during the study period.Conclusions: Renal damage progression in patients with IgA nephropathy was associated with microscopic hematuria at clinical onset, increased serum creatinine level, increased proteinuria, and grading of histological lesions. Our classification system appears simpler than other classifications and is associated with ESRD risk, which could help identify individual high-risk patients and stratify patients enrolled in randomized clinical trials into homogeneous groups.