Clinicopathological features and renal dysfunction risk factors of IgA nephropathy patients presenting with mild proteinuria
-
摘要: 目的 分析少量蛋白尿IgA肾病（IgAN）患者临床特征，探讨少量蛋白尿IgAN患者肾功能损伤相关危险因素。方法 回顾性分析2015年12月至2016年12月于武汉大学人民医院肾内科住院治疗并确诊原发性IgAN患者临床资料及病理资料，按照24h尿蛋白定量分为少量蛋白尿组（<1 g/24h）及中大量蛋白尿组（≥ 1 g/24h），并将少量蛋白尿组患者分为肾功能正常组[肾小球滤过率（eGFR）>90 ml·min-1·（1.73 m2）-1]和肾功能受损组[eGFR<90 ml·min-1·（1.73 m2）-1]，比较各组临床资料及病理资料，分析各临床指标与肾功能损伤相关性并分析肾功能下降危险因素。结果 302例原发性IgAN患者纳入本研究，其中少量蛋白尿患者116例（38.41%），中大量蛋白尿患者186例（61.59%）。少量蛋白尿组患者血肌酐、血尿素氮、血尿酸水平均明显低于中大量蛋白尿组，差异有统计学意义（均P<0.05）。慢性肾脏病分期以慢性肾脏病（CKD）1期为主，Lee氏分级以Lee氏Ⅰ~Ⅱ级为主。亚组间比较，肾功能损伤亚组患者年龄大，高血压及高尿酸血症患病率高，病理损伤较重，以Lee氏Ⅲ级为主，差异有统计学意义（均P<0.05）。多元线性回归分析显示，年龄及血尿酸与少量蛋白尿IgAN患者eGFR呈负相关（均P<0.05）。结论 少量蛋白尿IgAN患者病理表现亦可能较重，年龄、血尿酸是预测少量蛋白尿IgAN肾功能损伤独立危险因素，需积极干预治疗以改善患者预后。Abstract: Objective To analyze the clinical and pathological features of IgA nephropathy patients presenting with mild proteinuria and to describe risk factors associated with kidney injury.Methods The general and pathological data of patients with primary IgA nephropathy treated in our department from December 2015 to December 2016 were analyzed retrospectively. According to the 24-h total proteinuria, patients were divided into mild proteinuria group (<1 g/24h) and massive proteinuria group (≥ 1 g/24h), and the mild proteinuria group was divided into renal dysfunction subgroup[eGFR<90 ml·min-1·(1.73 m2)-1] and normal renal function subgroup[eGFR ≥ 90 ml·min-1·(1.73 m2)-1]. The clinicopathological data of different groups and subgroups were compared and the risk factors of renal dysfunction were analyzed.Results Of 302 patients with primary IgA nephropathy enrolled in this study, there were 116 (38.41%) cases of mild proteinuria and 186 (61.59%) cases of massive proteinuria. The levels of serum creatinine, blood urea nitrogen and blood uric acid in patients with mild proteinuria were significantly lower than those in patients with massive proteinuria. Patients with CKD 1 stage and Lee's Ⅰ-Ⅱ grades made up the most part of the mild proteinuria group, with the difference being statistically significant (P<0.05). As compared with the normal renal function subgroup, patients were older, the percentage of hypertension and hyperuricemia was higher, and pathological injuries were severer, mainly in the Lee's grade Ⅲ in the renal injury subgroup (P<0.05). Multiple linear regression analysis indicated that age and level of serum uric acid were negatively correlated with eGFR of patients with mild proteinuria (P<0.05).Conclusions The pathological lesions of IgA nephropathy patients with mild proteinuria may be severe. Age and serum uric acid are independent risk factors for predicting renal dysfunction. Active intervention should be taken to improve the outcome of these patients.
-
Keywords:
- IgA nephropathy /
- Proteinuria /
- Renal function injury
-
-
[1] Rodrigues JC, Haas M, Reich HN. IgA nephropathy[J]. Clin J Am Soc Nephrol, 2017, 12(4):677-686.
[2] 马明明, 管保章, 罗丽花,等. 50例增生硬化性IgA肾病的临床病理特点及激素治疗疗效分析[J]. 中华肾脏病杂志, 2016, 32(8):568-572. [3] 中华医学会儿科分会肾脏学组. 原发性IgA肾病诊治循证指南(2016)[J]. 中华儿科杂志, 2017, 55(9):643-646. [4] 邓卫,周倩,刘文婷,等. 不同性别原发性IgA肾病患者的临床病理特征[J]. 中华肾脏病杂志, 2015, 31(8):561-566. [5] Tan M, Li W, Zou G, et al. Clinicopathological features and outcomes of IgA nephropathy with hematuria and/or minimal proteinuria[J]. Kidney Blood Press Res, 2015, 40(2):200-206.
[6] Coresh J, Turin TC, Matsushita K, et al. Decline in estimated glomerular filtration rate and subsequent risk of end-stage renal disease and mortality[J]. JAMA, 2014, 311(24):2518-2531.
[7] 中国慢性肾脏病患者合并高尿酸血症诊治共识专家组.中国慢性肾脏病患者合并高尿酸血症诊治专家共识[J]. 中华肾脏病杂志, 2017, 33(6):463-469. [8] Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease:a position statement from kidney disease:Improving Global Outcomes (KDIGO)[J]. Kidney Int, 2005, 67(6):2089-2100.
[9] Wyatt RJ, Julian BA. IgA nephropathy[J]. N Engl J Med, 2013, 368(25):2402-2414.
[10] Gutiérrez E, Zamora I, Ballarín JA, et al. Long-term outcomes of IgA nephropathy presenting with minimal or no proteinuria[J]. Am Soc Nephrol, 2012, 23(10):1753-1760.
[11] Lee H, Jin HH, Jin HP, et al. Long-term prognosis of clinically early IgA nephropathy is not always favorable[J]. BMC Nephrol, 2014, 15(1):1-9.
[12] Trimarchi H, Barratt J, Cattran DC, et al. Oxford Classification of IgA nephropathy 2016:an update from the IgA Nephropathy Classification Working Group[J]. Kidney Int, 2017, 91(5):1014-1021.
[13] Lv J, Shi S, Xu D, et al. Evaluation of the Oxford Classification of IgA nephropathy:a systematic review and meta-analysis[J]. Am J Kidney Dis, 2013, 62(5):891-899.
[14] Bakan A, Oral A, Elcioglu OC, et al. Hyperuricemia is associated with progression of IgA nephropathy[J]. Int Urol Nephrol, 2015, 47(4):673-678.
[15] Zhou J, Chen Y, Liu Y, et al. Plasma uric acid level indicates tubular interstitial leisions at early stage of IgA nephropathy[J]. Bmc Nephrology, 2014, 15(1):11-16.
[16] Mulay SR, Evan A, Anders H. Molecular mechanisms of crystalrelated kidney inflammation and injury:implications for cholesterol embolism, crystalline nephropathies and kidney stone disease[J]. Nephrol Dial Transpl, 2014,29(3):507-514.
[17] Isaka Y, Takabatake Y, Takahashi A, et al. Hyperuricemia-induced inflammasome and kidney diseases[J]. Nephrol Dial Transplant, 2016, 31(6):890-896.
[18] 沈子妍, 章晓燕, 丁小强. 尿酸肾损伤的研究进展[J]. 上海医学, 2017, 40(1):60-64. [19] An LL, Mehta P, Xu L, et al. Complement C5a potentiates uric acid crystal-induced IL-1β production[J]. Eur J Immunol, 2014, 44(12):3669-3679.
[20] Mallat SG, Kattar SA, Tanios BY, et al. Hyperuricemia, hypertension, and chronic kidney disease:an emerging association[J]. Curr Hypertens Rep, 2016, 18(10):74-79.
计量
- 文章访问数: 378
- HTML全文浏览量: 0
- PDF下载量: 359
下载:
.png)