IgA肾病患者高尿酸血症的影响因素分析

目的 探讨IgA肾病(IgA nephropathy,IgAN)并高尿酸血症患者相关因素.方法 纳入2015年1月至2019年12月在昆明医科大学第二附属医院肾脏内科行肾穿刺活检诊断为原发性Ig A N的患者.根据血尿酸值将患者分为高尿酸组和正常尿酸组,记录患者的基线资料,临床病理特征,并行Logistic回归分析与高...     

高尿酸血症与IgA肾病的关系

IgA肾病（IgAnephropathy,IgAN）是以肾小球系膜区[gA或以IgA为主的免疫球蛋白沉积为特征的免疫性肾小球肾炎,是世界范围内最常见的原发性肾小球疾病。部分IgAN持续进展,大约10％-20％的IgAN患者在’肾活检病理诊断后10年内进入终末期肾病,因此,寻找促进IgAN进展的因素具有重要意义。国外研究表明,高尿酸血症是影响IgAN预后的独立危险因素,伴有高尿酸血症的IgAN患者不良预后的危险性为血尿酸水平正常者的2．4倍。确定高尿酸血症与IgAN的关系及降低血尿酸水平是否有益于IgAN的预后,是近年来的研究热点之一。     

IgA肾病合并高尿酸血症1例

病　　例患者 ,男性 ,2 6岁 ,汽车修理工。因眼睑及双下肢浮肿3月余于 1999年 11月 10日以“慢性肾小球肾炎 ,慢性肾衰竭代偿期”收入我科。病人 3个月前无明显诱因眼睑及双下肢膝关节以下可凹性浮肿 ,活动后双侧腰部隐痛。曾有数日第一跖趾关节红、肿、痛 ,活动受限 ,自行缓解。 1999年 8月 6日住当地医院 ,测Ｂｐ18/ 9.3ｋＰａ ;查尿常规 :尿蛋白30 0ｍｇ/ｄＬ左右 ,颗粒管型 1～ 2个 /高倍视野 ,血尿素氮 7～12ｍｍｏｌ/Ｌ ,血肌酐 132～ 2 0 2 μｍｏｌ/Ｌ ,胆固醇 12 .1～ 5 .1ｍｍｏｌ/Ｌ ,甘油三酯 7.0 6ｍｍｏｌ/Ｌ ,白蛋白不详。诊…     

影响IgA肾病高尿酸血症的因素

目的:探讨IgA肾病高尿酸血症的影响因素及其与肾内动脉病变的关系.方法:对648例IgA肾病患者进行回顾性研究,应用多元回归的统计学方法分析高尿酸血症发生的影响因素.结果:IgA肾病患者中高尿酸血症的发生率为29.6%.与高尿酸血症独立相关的因素为:血清肌酐升高、高甘油三酯血症、高血压、肥胖及肾内动脉病变.血尿酸的水平与IgA肾病肾内动脉病变的程度密切相关.结论:有效地控制血压和体重、降低血脂及血尿酸水平,可望减轻肾内动脉病变,延缓IgA肾病的进展.     

IgA肾病患者合并高尿酸血症临床及病理特征分析

目的探讨IgA肾病高尿酸血症的临床病理特征及相关危险因素。 方法选取2010年1月至2015年7月于山西医科大学第二医院行经皮肾穿刺活检确诊为IgA肾病的188例患者,根据血尿酸水平将患者分为正常血尿酸组与高尿酸血症组,收集患者一般资料、尿蛋白定量、肾功能等临床生化指标以及病理指标,并对肾脏病理组织进行牛津病理分型。分析两组患者临床表现、肾脏病理特点,应用多元回归统计学方法分析高尿酸血症发生的影响因素。其他数据采用SPSS13.0软件进行统计分析。 结果本研究中心188例IgA肾病患者中合并高尿酸血症的患者有42例,高尿酸血症发生率为22.3%;高尿酸血症组中男性患者36例,女性患者6例;与正常血尿酸组(男性患者61例、女性患者85例)相比,高尿酸血症组男性患者明显增多(χ²＝25.2,P<0.001)。本组研究IgA肾病患者肾脏组织牛津病理分型以M1E1S0T0多见;与正常血尿酸组比较,高尿酸血症组患者肾小管－间质损伤重,差异有统计学意义(χ²＝5.056,P＝0.025)。肾组织免疫复合物IgA沉积于毛细血管袢者高尿酸血症发生率明显升高(χ²＝44.69,P<0.001)。IgA肾病患者合并高尿酸血症的相关因素为性别、体质量指数、甘油三酯、IgA沉积于毛细血管袢。 结论IgA肾病高尿酸血症的危险因素为男性、肥胖、高甘油三酯血症,并可能与IgA在毛细血管区沉积相关。     

IgA肾病合并高尿酸血症患者的临床病理分析

目的探讨IgA肾病合并高尿酸血症患者的临床及病理变化的特点,以期揭示IgA肾病伴有高尿酸血症的临床意义。方法回顾性分析2006年6月至2012年12月厦门大学附属中山医院肾内科收治的270例经肾活检确诊的原发性IgA肾病患者,依据血尿酸水平,将270例IgA肾病患者分为高尿酸血症组和尿酸正常组,测定记录所有患者的性别、发病年龄、收缩期血压、24 h尿蛋白定量、血尿酸、血肌酐、血白蛋白、血脂等临床指标,所有患者均进行肾脏病理检查并行Lee分级,统计分析2组的临床和病理特点,并对肾功能正常患者(135例)的病理指标进一步行亚组分析。结果IgA肾病患者高尿酸血症的患病率为25.19%,高尿酸血症组患者年龄、血白蛋白、血三酰甘油、血清总胆固醇水平与尿酸正常组比较,差异无统计学意义,患者男性比例、收缩期血压、24 h尿蛋白定量、血肌酐水平均高于尿酸正常组(P0.05),高尿酸血症组患者肾脏病理Lee分级严重的比例及发生肾小管间质病变、肾内动脉病变的比例均高于尿酸正常组(P0.05)。正常肾功能患者中,高尿酸血症组出现动脉壁肥厚等肾内动脉病变及肾小管间质慢性病变的比例亦高于尿酸正常组(P0.05)。结论 IgA肾病合并高尿酸血症患者与尿酸正常组患者比较,临床表现及肾脏病理损伤多较重,尤其对肾小管间质病变及肾内血管病变影响更明显,临床预后不佳,应予重视并及时有效地进行干预治疗。     

IgA肾病高尿酸血症临床与病理相关性研究

目的:探讨IgA肾病合并高尿酸血症发生与临床影响因素和病理特点之间相关性。方法:回顾性分析2015年1月~2016年10月住院并同步肾穿刺活检明确诊断为IgA肾病患者141例,根据血尿酸水平分为高尿酸血症组43例,非高尿酸血症组98例,比较两组患者临床一般资料、实验室检查指标和病理学特征,采用Logistic回归分析IgA肾病高尿酸血症发生的相关危险因素。结果:IgA肾病患者高尿酸血症发病率约为30.5%,与高尿酸血症独立相关的因素包括:高血压、肥胖和高甘油三酯血症、血清尿素氮、肌酐升高和肾血管病变。IgA肾病高尿酸血症与代谢性因素如高血压、肥胖和高甘油三脂血症和血管病变程度密切相关。结论:IgA肾病患者高尿酸血症发病率高[高],血压高、体重大、合并脂质代谢紊乱、肾功能下降和血管病变易并发高尿酸血症。     

IgA肾病合并高尿酸血症患者临床及病理特点分析

目的:探讨IgA肾病合并高尿酸血症分发病率及临床和病理特点。方法:将经过肾活检明确诊断的原发性IgA肾病132例患者按着尿酸水平和血肌酐水平进行分组,比较其临床特点及病理特点差异。结果:高尿酸血症在CKD3期及以上的患病率显著高于CKD1期及CKD2期的患病率。高尿酸血症组的患者较尿酸正常组高血压发生率,24 h尿蛋白定量,血清胆固醇水平,以及BMI水平显著升高,其Lee氏分级主要表现为Ⅲ级,随着Lee氏分级的加重,高尿酸血症的患病率明显增加。高血尿酸组患者肾脏病理球性硬化,肾小管间质积分、血管病变积分,肾小管萎缩均高于非高尿酸组。在CKD3期及以上患者的亚组中,高尿酸血症患者的临床表现及病理表现更为严重。结论:IgA肾病合并高尿酸血症的患者,在肾小球滤过率下降的患者中间发病率更高,其临床和病理损伤均重于尿酸正常的IgA肾病患者。     

IgA肾病患者高尿酸血症患病率及其相关危险因素分析

目的 探讨IgA肾病患者高尿酸血症的患病率及其临床、病理危险因素.方法 回顾性分析1996年1月至2012年12月于中山大学附属第一医院行肾穿刺活检确诊为IgA肾病的2566例患者的临床及病理特征,行多因素Logistic回归分析IgA肾病患者高尿酸血症发生的影响因素.结果 2566例IgA肾病患者中,高尿酸血症的患病率为36.6％,其中CKD 1～5期各期患者高尿酸血症的患病率分别为16.2％、37.4％、66.4％、87.7％和76.4％.IgA肾病患者伴发高尿酸血症的相关危险因素包括:男性、CKD分期高、肾活检病理球性硬化比例高.肾功能正常(CKD 1～2期)IgA肾病患者伴发高尿酸血症的相关危险因素包括:男性、CKD分期高、血胆固醇水平升高及肾活检病理球性硬化比例高.肾功能受损(CKD 3～5期)IgA肾病患者伴发高尿酸血症的相关危险因素包括:CKD分期高及肾活检病理球性硬化比例高.结论 IgA肾病患者高尿酸血症的患病率为36.6％,明确IgA肾病肾功能正常及受损患者发生高尿酸血症的相关危险因素有利于本病的综合防治.     

不同性别对进展性IgA肾病患者合并高尿酸血症的研究

目的:观察不同性别和尿酸水平进展性Ig A肾病中对疾病的影响。方法:回顾性分析2008年1月~2014年12月,诊断为Ig A肾病LEEⅢ级及以上且尿蛋白1 g的患者110例。根据性别和血尿酸水平分组,观察各因素对患者进入终点事件的影响。结果:男性高尿酸组较正常组,年龄、e GFR、进入终点事件差异无统计学意义(P0.05);女性高尿酸组较正常组e GFR下降幅度大,差异有统计学意义(P0.05);高尿酸组e GFR变化率,女性较男性下降幅度大,差异有统计学意义(P0.05);女性患者中,高尿酸组进入终点事件显著增多(χ2=8.952,P=0.003)。结论:进展性Ig A肾病患者中,高尿酸血症可导致更严重肾功能损害,在不同性别中有差异。     

Related factors of hyperuricemia in IgA nephropathy patients

Objective To investigate the influencing factors of hyperuricemia in patients with IgA nephropathy (IgAN). Methods A retrospective study was performed in patients with renal biopsy diagnosed as IgAN in the Department of Nephrology, Provincial Hospital of Anhui Medical University from January 2016 to October 2018. According to the blood uric acid level, they were divided into two groups: patients with hyperuricemia and patients without hyperuricemia. The general clinical indicators and renal pathological data were compared between the two groups. Logistic regression model was used to analyze the influencing factors of hyperuricemia in IgAN patients. Results A total of 125 IgAN patients with age of (35.70±11.16) years old were enrolled, including 63 males and 62 females. The morbidity of hyperuricemia was 44.0%(55/125). Compared with the normal blood uric acid group, the blood urea nitrogen, serum creatinine and the proportion of chronic kidney disease (CKD) stage 3-5, small arterial wall thickening, fibrous crescents/globules, renal interstitial fibrosis, renal tubular atrophy, glomerular sclerosis and inflammatory cell infiltration in the hyperuric acid group were higher, while the level of estimated glomerular filtration rate (eGFR) was lower. And the differences were statistically significant (all P＜0.05). Multivariate logistic regression analysis showed that the level of serum creatinine was an independent related factor of hyperuricemia in IgAN patients (OR=1.034, 95%CI 1.005-1.064, P=0.021). Conclusions IgAN patients with hyperuricemia presented more severe glomerular, tubular and interstitial lesions, and the level of serum creatinine is an independent related factor of hyperuricemia in IgAN patients. High uric acid level may have an important influence on the progression of IgAN, so good control of serum uric acid may improve the prognosis of patients with IgAN.     

高尿酸血症与IgA肾病临床和病理表现的关系

目的分析IgA肾病合并高尿酸血症患者的临床和病理特征。方法将228例IgA肾病患者分为血尿酸正常组（154例）和高尿酸血症组（74例）,回顾性分析2组患者的年龄、血尿酸、估算肾小球滤过率（eGFR）、24h尿蛋白定量、总胆固醇（Tc）、血白蛋白（Alb）以及肾脏病理改变的差异。结果与血尿酸正常组相比,高尿酸血症组的尿蛋白明显增多（P〈0．01）,eGFR显著降低（P〈0．01）,肾小球球性硬化比率显著升高（P〈0．05）,肾小球细胞增殖程度和。肾小管间质损伤程度显著加重（P〈0．0B）,肾内动脉病变的发生率显著增高（P〈0．05）。Spearman相关分析显示,eGFR与肾小球硬化的比例呈负相关（r=-0．308、P〈0．01）、与肾小球细胞增殖程度呈负相关（r=-0．170,P〈0．01）、与肾小管间质受损的程度呈负相关（r=-0．409,P〈0．01）;而血尿酸与肾小球硬化的比例呈正相关（r=0．147,P〈0．05）、与。肾小球细胞增殖程度呈正相关（r=0．193,P〈0．01）、与肾小管间质受损的程度呈正相关（r=0．219,P〈0．01）;24h尿蛋白定量与肾小球细胞增殖程度呈正相关（r=0．259,P〈0．01）、与肾小管间质受损的程度呈正相关（r=0．225,P〈0．01）。结论高尿酸血症与IgA肾病患者的临床和病理损害相关。     

135例单纯镜下血尿型IgA肾病随访分析

目的观察单纯镜下血尿型IgA肾病患者的预后及影响因素。方法经肾活检确诊的单纯镜下血尿型IgA肾病135例,其中伴有微量白蛋白尿85例,不伴有微量白蛋白尿50例,平均随访（92±28）个月。组间比较采用t检验,预后危险因素采用逐步回归分析。结果随访结束时,135例中16例（12％）血尿缓解,39例（29％）合并出现蛋白尿,43例（32％）出现高血压,25例（19％）出现肾功能减退。伴有微量白蛋白尿的患者,病程中更易出现蛋白尿和高血压。血尿、微量白蛋白尿、肾间质小管病变与肾功能减退呈显著相关性。结论单纯镜下血尿型IgA肾病并非肯定预后良好,对部分患者应密切随访和积极治疗。     

Long-term follow-up of patients with IgA nephropathy treated with prednisolone and cyclophosphamide therapy

BACKGROUND: Analyses of selected cases suggest that immunosuppressive treatment could reduce proteinuria and delay the progression of immunoglobulin A nephropathy (IgAN). The aim of this study was to examine the long-term effectiveness of this therapy on the clinical course of IgAN. We also examined the relationship between the efficacy of the treatment and the suppression of the serum immunoglobulin level. METHODS: Eighteen patients who were observed for more than 2 years after prednisolone and cyclophosphamide therapy were enrolled in this study. Their clinical and laboratory characteristics were recorded for 2-18 years (mean 7.8 +/- 5.7 years). RESULTS: Of the 18 patients, 13 had remission of proteinuria. We observed the subsequent development of proteinuria in four patients. Fourteen patients had remission of hematuria, with five patients experiencing subsequent relapse of hematuria. The mean time from the treatment to the relapse of proteinuria or hematuria was 5.8 years. Serum immunoglobulins were suppressed by the combination therapy. Serum IgG and IgM recovered 6 months after the treatment, whilst the suppression of serum IgA lasted for 4 years. We found a positive correlation between the serum IgA level and the degree of proteinuria. CONCLUSION: This study indicates that long-term follow-up is essential in order to prove the long-term benefit of immunosuppressive therapy in patients with IgAN. Careful monitoring of the serum IgA level may be useful in the follow-up of patients with IgAN, especially when they are treated with immunosuppressive agents.     

Cryoglobulinaemia and cryofibrinogenaemia in IgA nephropathy: a follow-up study

Sera and plasmas from 50 patients with IgA nephropathy (IgA-NP) have been investigated for the presence of cryoglobulin (CG) and cryofibrinogen (CF), respectively, 2-5 cryoprotein determinations being made for each patient. CG was transiently found in 20 of 50 patients (40%), but in none of 20 healthy blood donors, whereas CF was found in 37 of 50 patients (74%) and in 4 of 20 healthy blood donors. The cryoprecipitates were of single and mixed component types. All but 2 of the patients with CF had haematuria. Nearly all of them had histories of long exposure to the cold as manual workers at the onset or recognition of their disease. There was no clinical remission during a 2-to-5-year follow-up if cryoproteinaemia persisted. A certain correlation was detected between the composition of the CP and the renal immunohistological findings. It is suggested that renal deposition of circulating CF or local formation of CF might be responsible for the tubulo-interstitial fibrocellular changes, which are of prognostic importance.     

Prognostic value of urinary interleukin 6 in patients with IgA nephropathy: an 8-year follow-up study

We evaluated the significance of urinary IL-6 levels in the prediction of long-term renal outcome in patients with IgA nephropathy (IgAN). Fifty-nine patients with biopsy-proven IgAN were enrolled in this study. All patients had a creatinine clearance (Ccr) greater than 80 ml/min and normal serum creatinine concentration (Scr) on enrollment and were followed for 8.07 +/- 1.72 years. Twenty- four-hour urine samples were obtained and urinary IL-6 was measured by ELISA. Fifteen patients exhibited a worsening of renal function (progressor). Renal function of the remaining 44 patients was stable during follow-up (non-progressor). The urinary IL-6 levels of progressors on enrollment were significantly higher than those of non-progressors (3.8 +/- 3.8 and 1.8 +/- 1.5 ng/day, respectively, p = 0.0138). We calculated the risk ratio for the progression to renal failure. Patients with a urinary IL-6 level greater than 2.5 ng/day at diagnosis had a 7.8-fold higher risk for the progression of the disease (95% CI 1.31-46.47, p = 0.024) compared with those whose urinary IL-6 level was less than 1.0 ng/day. In conclusion, urinary IL-6 levels could be used as a predictor of long-term renal outcome in patients with IgAN. Patients with a urinary IL-6 level greater than 2.5 ng/day at diagnosis may have a worse prognosis.