Uric acid correlates with the severity of histopathological parameters in IgA nephropathy
Uric acid correlates with the severity of histopathological parameters in IgA nephropathy
复制标题
DOI：
10.1093/ndt/gfh584
复制
发表时间：
2005-01-01
影响因子：
6.1
通讯作者：
Mustonen, J
中科院分区：
文献类型：
--
作者：
Myllym채ki, J;Honkanen, T;Mustonen, J
背景免疫球蛋白A肾病（IgAN）是世界范围内最常见的慢性肾小球肾炎。许多临床和组织病理学进展的危险因素已被发现。最近，代谢危险因素，如高尿酸血症和高尿酸血症，也已与IgA肾病的进展。在本研究中，我们在202例IgAN患者的临床和代谢危险因素与组织病理学参数。肾小球、肾小管间质和血管组织的形态学改变被半定量地分为三类。免疫组化Ki-67（MIB-1）、CD 45（LCA）、CD 68染色检测系膜细胞增殖活性和炎症细胞数量。测定血尿酸、甘油三酯、胆固醇、尿蛋白排泄量（UPE）、血压和体重指数（BMI）。吸烟习惯和糖尿病的发生率也进行了评估。多因素分析显示血尿酸在肾脏形态学改变中的独立作用。血尿酸和UPE水平与几个组织学参数相关。尿酸水平与肾小管间质改变相关性最强，UPE与肾小球硬化相关性最强。血清甘油三酯水平与肺间质纤维化和透明小动脉硬化相关。血压与透明小动脉硬化、肾小球硬化和肾小管间质改变相关。BMI和糖尿病与肾小管间质和血管改变相关。我们没有发现组织病理学参数和吸烟习惯或血清胆固醇水平之间的显着相关性。血尿酸与肾小管萎缩、间质纤维化和炎症的存在独立相关。我们的结论是，许多代谢因素是univariately与肾脏形态学的研究结果在IgA肾病。这些相同的因素在代谢或胰岛素抵抗综合征中是中心的，并且可能在IgAN的进展中具有致病作用。血尿酸可能在IgAN患者肾小管间质病变的发展中起独立作用，并与肾组织炎症相关。
Background. Immunoglobulin-A nephropathy (IgAN) is the most common chronic glomerulonephritis worldwide. Many clinical and histopathological risk factors for progression have been found previously. Recently, metabolic risk factors, such as hyper-uricaemia and hypertriglyceridaemia, also have been associated with the progression of IgAN.Methods. In the present study we correlated clinical and metabolic risk factors with histopathological parameters in 202 patients with IgAN. Morphological changes in glomerular, tubulointerstitial and vascular tissue were semiquantitatively graded into three classes. Mesangial proliferation activity and the amount of inflammatory cells were also evaluated by immunohistochemical staining of Ki-67 (MIB-1), CD45 (LCA) and CD68 stainings. Serum uric acid, triglycerides and cholesterol, urine protein excretion (UPE), blood pressure and body mass index (BMI) were measured. Smoking habits and Occurrence of diabetes mellitus also were evaluated. The independent role of serum uric acid in the development of renal morphological changes was evaluated in Multivariate analysis.Results. Serum uric acid and UPE level correlated with several histological parameters. Uric acid level showed the strongest correlation with tubulointerstitial changes and UPE with glomerulosclerosis. The level of serum triglycerides correlated with interstitial fibrosis and hyaline arteriolosclerosis. Blood pressure correlated with hyaline arteriolosclerosis, glomerulosclerosis and tubulointerstitial changes. BMI and diabetes mellitus correlated with both tubulointerstitial and vascular changes. We found no significant correlations between histopathological parameters and smoking habits or serum cholesterol level. Serum uric acid had independent associations with the presence of tubular atrophy and interstitial fibrosis and inflammation.Conclusions. We conclude that many metabolic factors are univariately associated with renal morphological findings in IgAN. These same factors are central in the metabolic or insulin resistance syndrome and may have a pathogenetic role in the progression of IgAN. Serum uric acid may have an independent role in development of tubulointerstitial lesions as well as being associated with inflammation in renal tissue of patients with IgAN.