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

调查 glomerular 密度( GD )是否能是为 IgA nephropathy 与的病人的一个独立预示的因素的目的与时间一般水准 proteinuria 每 1.73 m 2,或为病人估计了 30～60 ml/min 的 glomerular 过滤率( eGFR )<有证实活体检视的 IgA nephropathy 的 173 个病人全部的 0.5 g/d.Methods A 诊断了从2000年1月被包括到2010年12月。所有这些病人被跟随在上面为超过 5 年。端点是一 > 在从在 5 年的后续以后的基线的 eGFR 的 30% 衰落。GD 的最佳的截止价值被巨鸟曲线计算。Kaplan-Meier 方法和考克斯回归分析被用于幸存 analysis.Results A 在 eGFR 的 30% 衰落发生在 14.5% 所有病人。GD 的最佳的诊断截止价值是 1.99/mm 2(AUC = 0.90，敏感 =84.0% ，特性 =81.8%) 由巨鸟曲线决定了。低 GD 组(GD < 1.99 每 1.73 m 2 与 30 ～ 60 ml/min 的 eGFR 为病人在肾的端点每公里 2) 经历了重要增加(在更低的 GD 的六个病人组织，当时在另外的组的一个病人) 。为有时间一般水准 proteinuria 的病人 < 0.5 g/d，更低的 GD 组从基线显示出更高的 eGFR 衰落(4.5？？

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.