伴少量新月体形成IgA肾病重复肾活检资料分析

Clinicopathological Analysis for Repeated Renal Biopsy in Patients with IgA Nephropathy with Partial Crescentic Formation

目的探讨免疫抑制剂治疗伴少量新月体形成的IgA肾病的疗效。方法回顾性分析伴新月体形成的IgA肾病患者免疫抑制治疗前后两次肾活检时临床和病理资料。结果24例IgA肾病患者首次肾活检时发现均伴有细胞性新月体,均接受免疫抑制治疗,未发现严重不良反应。两次肾活检时血压、肌酐和肾小球滤过率差异无统计学意义。重复活检时血红蛋白和白蛋白上升(P均<0.05)。24h尿蛋白定量明显减少(P=0.000)。两次肾活检系膜区IgA、C3荧光强度比较,差异无统计学意义。重复活检时肾小球系膜细胞增生明显减轻,但球性硬化肾小球比例升高,肾小管间质纤维化明显加重。尽管两次肾活检细胞性新月体比例比较,差异无统计学意义,但有降低趋势。其中有12例患者在第2次肾活检时细胞性新月体完全消失。节段硬化、球囊粘连和间质炎性细胞浸润比较,差异无统计学意义。结论IgA肾病即使伴少量细胞性新月体形成也要尽早干预。免疫抑制治疗在短期内能明显减少尿蛋白、稳定肾功能、改善贫血和减轻肾脏急性病变。最佳的治疗方案仍有待于明确。必要时还要重复肾活检调整治疗方案。

Objective To investigate the efficacy of immunosuppressive agents in the treatment of IgA nephropathy with a small amount of crescentic formation.Methods Clinical and pathological data of IgA nephropathy patients with partial crescent formation who received repeat renal biopsies were retrospectively analyzed in our kidney division.Results Cellular crescent bodies were found in 24 IgA nephropathy patients at the first renal biopsy.All patients received immunosuppressive therapy without serious adverse reactions.There was no significant difference in blood pressure,creatinine and glomerular filtration rate between two renal biopsies.At the second biopsy,the hemoglobin and albumin increased.24-h urinary protein excretion decreased significantly.There was no significant difference in the fluorescence intensity of IgA and C3 between two renal biopsies.The mesangial cell proliferation were decreased significantly,but the proportion of global glomerulosclerosis and tubulointerstitial fibrosis were significantly increased.Although there was no statistical significance in the proportion of glomerular crescent formation between two renal biopsies,there was a decrease tendency,even completely disappeared in 12 patients disappeared during second renal biopsy.There was no significant difference in segmental sclerosis,balloon adhesion and interstitial inflammatory cell infiltration.Conclusion Early intervention is necessary even IgA nephropathy with partial cellular crescent formation.The immunosuppressive therapy of IgA nephropathy with partial cellular crescent can obviously reduce proteinuria,stabilize renal function,improve anemia and reduce acute kidney injury without overt adverse effects in a short-term follow-up.However,there is still a chronic progress trend.The optimal treatment remains to be clarified.Repeat renal biopsy is conducted if necessary.