Title: [Clinicopathologic features and prognosis of patients with IgA nephropathy superimposed on transplant glomerulopathy].
Abstract: Objective: To observe the clinicopathologic features and prognostic of patients with IgA nephropathy (IgAN) superimposed on transplant glomerulopathy (TG+ IgAN). Methods: Electronic medical records of Jinling Hospital were searched for TG+ IgAN patients that was diagnosed during January 2004 to December 2016. Clinicopathologic features and prognoses information were retrieved and analyzed. The primary outcome was initiation of replacement therapy or an eGFR declined to<15 ml·min(-1)·(1.73m(2))(-1). Results: A total of 49 patients with pathologically confirmed TG+ IgAN were enrolled in this study. The median time from renal transplantation to allograft biopsy was 85 months. There were 131 patients with TG in the control group. There was no statistical difference in the age, gender, and immunosuppressive regimen during renal biopsy in the two groups. In TG+ IgAN patients, the median serum creatinine level was 175 μmol/L, the median urinary protein was 1.45 g/24 h, and 16.3% of the patients had nephrotic range proteinuria, the incidence of microscopic hematuria was 40.8%, and the average hemoglobin was 105 g/L. In terms of pathology, the degree of glomerular mesangial matrix hyperplasia in the TG+ IgAN group was significantly heavier compared with TG group (P=0.004), and the degree of hyaline degeneration of the small arteries was lighter (P=0.043). There was no significant difference in interstitial inflammation (i), tubulitis (t), glomerulitis (g), peritubular capillaritis (ptc) and intimal arteritis (v). Calculated by Kaplan-Meier method, the median survival time of 49 patients with TG+ IgAN was 36.9 months, and there was no difference in survival rate of allografts compared with TG group. Conclusions: Compared with TG patients without IgA, TG+ IgAN patients had higher incidence of microscopic hematuria, more severe glomerular mesangial matrix hyperplasia, and no significant differences in other clinicopathological features. The prognosis of TG+ IgAN patients was not significantly different from those without IgAN.目的: 总结分析移植肾肾小球病(TG)合并IgA肾病(IgAN)(TG+ IgAN)患者的临床、病理及预后特征。 方法: 通过电子病历系统搜集东部战区总医院2004年1月至2016年12月间收治的诊断为TG+ IgAN的肾移植受者资料,总结其临床病理特点和转归。随访终点定义为估算的肾小球滤过率(eGFR)<15 ml·min(-1)·(1.73m(2))(-1)或再次接受肾脏替代治疗。 结果: 本研究共纳入病理确诊的TG+ IgAN患者49例,移植肾活检距肾移植中位时间为85个月。对照组TG患者131例,两组患者年龄、性别比例、免疫抑制方案的差异均无统计学意义。临床表现方面,TG+ IgAN患者移植肾活检时中位血清肌酐水平为175 μmol/L,中位尿蛋白定量为1.45 g/24 h,16.3%的患者表现为肾病范围蛋白尿,镜下血尿的发生率为40.8%,平均血色素为105 g/L;与不合并IgAN的TG患者相比,TG+ IgAN患者eGFR、尿蛋白、尿视黄醇结合蛋白(RBP)、β-N-乙酰葡萄糖苷酶(NAG)、血色素以及血淋巴细胞CD4、CD8差异均无统计学意义。病理方面,与不合并IgAN的TG组相比,TG+ IgAN组患者肾小球系膜基质增生的程度明显较重(P=0.004),小动脉透明变性的程度较轻(P=0.043),其他病理表现,如间质炎症和小管炎(i+t)、动脉炎(v)、肾小球炎(g)、肾小管周毛细血管炎(ptc)程度及C4d阳性比例的差异均无统计学意义。经Kaplan-Meier法计算,49例TG+ IgA患者的中位生存时间为36.9个月,与不合并IgAN的TG组相比移植肾生存率差异无统计学意义。 结论: TG+ IgAN患者与不合并IgAN的TG患者相比,镜下血尿发生率高,肾小球系膜基质增生的程度明显较重,小动脉透明变性的程度较轻,其他临床病理特征无明显差别。TG+ IgAN患者的预后与不合并IgAN者差异无明显差别。.
Publication Year: 2019
Publication Date: 2019-03-26
Language: en
Type: article
Indexed In: ['pubmed']
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Cited By Count: 1
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