表现为孤立性血尿的IgA肾病的病理特征和转归

Pathological characteristics and outcome of IgA nephropathy presented with isolated hematuria

目的探讨表现为孤立性血尿的IgA肾病病理特征及其与预后关系。方法分析103例经肾活检确诊的呈孤立性血尿IgA肾病患者的临床和病理特征,并观察其转归。以Ser升高一倍为终点,用Kaplan-Meier生存曲线分析肾脏无事件存活率。结果呈孤立性血尿的lgA肾病Lee病理分级分布以Ⅱ-Ⅲ级为主,但有20.4％为LeeⅣ-Ⅴ级和12.7％有肾间质纤维化。经过(49.5±35.4)月的随访,Set水平从(73±16)μmol/L上升至(96±114)μmol/L,但差异无统计学意义(P>0.05)。患者3、5和10年肾存活率分别为100％、100％和85.7％。结论呈孤立性血尿的IgA肾病病理改变轻,中期预后好,但应注意临床与病理不符要并长期随访、监测肾功能进展的指标。

Objective To study the pathological characteristics and outcomes of IgA nephropathy presented with isolated hematuria.Methods Clinical and pathological characteristics of 103 patients with IgA nephropathy confirmed by renal biopsy and presented with isolated hematuria were reviewed. Doubling of serum creatinine was regarded as an event or endpoint and event-free renal survival was analyzed. Results Although patients were mainly of Lee's type Ⅱ-Ⅲ, there were 20.4% with Lee's grading of Ⅳ-Ⅴand 12.7% of patients with interstitial fibrosis. After an average of (49.5±35.4) months of follow-up, serum creatinine increased from (73±16)(μmol/L to (96±114)(μmol/L without statistically significant differences( P > 0.05 ). The 3-,5- and 10-year event-free renal survival of was 100%, 100% and 85.7%, respectively. Conclusions IgA nephropathy presented with isolated hematuria has mild pathological lesion and good medium-term outcome, although clinicopathological discrepancy might exits, suggesting the need of long-term follow-up of parameters indicating progression of the disease.