The Neglected Significance of Glomerular Density as a 5-year Progression Indicator for IgA Nephropathy  

作　　者：陈振杰[1] 李航[1] 蔡建芳[1] 张鑫[1] 李超[1] 邹佩美 李明喜[1] 陈丽萌[1] 李雪梅[1] 李学旺[1] 文煜冰[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肾内科,北京100730

出　　处：《Chinese Medical Sciences Journal》2017年第3期145-151,共7页中国医学科学杂志（英文版）

基　　金：Supported by the Key Projects in the National Science and Technology Pillar Program During the Twelfth Five-year Plan Period(2011BAI10B03)

摘　　要：Objective To investigate whether glomerular density （GD） could be an independent prognostic factor for patients of IgA nephropathy with estimated glomerular filtration rate （eGFR） of 30 to 60 ml/min per 1.73 m2, or for patients with time-average proteinuria 〈 0.5 g/d. Methods A total of 173 patients with biopsy-confirmed IgA nephropathy diagnosed from January 2000 to December 2010 were included. All of these patients were followed up for more than 5 years. The endpoint was a 〉 30% of decline in eGFR from baseline after 5-year follow-up. The optimal cut-off value of GD was calculated by ROC curve. Kaplan-Meier method and Cox regression analysis was used for survival analysis. Results A 30% of decline in eGFR occurred in 14.5% of all patients. The optimal diagnostic cut-off value of GD was 1.99/mm2 （AUC = 0.90, sensitivity = 84.0%, specificity = 81.8%） determined by ROC curve. The low GD group （GD 〈 1.99 per mm2） experienced a significant increase in renal endpoint for patients with eGFR of 30 to 60 ml/min per 1.73 m2 （six patients in lower GD group, while one patient in the other group）. For patients with time-average proteinuria 〈 0.5 g/d, the lower GD group showed a higher eGFR decline from baseline （4.5±16.7 ml/min per 1.73 m2 vs. –8.1±21.4 ml/min per 1.73 m2, P = 0.038）; two patients in this group reached the endpoint, while no patients in the higher GD group did. Conclusion GD could be an independent prognostic factor for patients of IgA nephropathy with eGFR at 30 to 60 ml/min per 1.73 m2 of body surface, particularly for those with time-averaged amount of urine protein less than 0.5 g per day.

关 键 词：glomerular density IgA nephropathy renal progression 

分 类 号：S858.291[农业科学—临床兽医学] O636[农业科学—兽医学]