Korean Journal of Nephrology 1996;15(3):317-328.
IgA 신병증 : 예후와 관련된 임상적 조직학적 지표
채현기 , 강경원 , 박문향 , 강종명
Abstract
A retrospective study of 201 patients with IgA nephropathy was undertaken to clarify possible correlations between clinical and hitologic features, and the prognosis of the disease during the period of January, 1985 through December, 1992 at Han- yang University HospitaL The results were as fol- lowings' 1) The prevalence of IgA nephropathy was 26.8%. IgA nephropathy was diagnosed in 346 cases among 1,290 biopsied patients. 2) The mean age of the patients was 28.7 years, and 66.7% were distributed between 20 to 39 years. Male to female ratio was 1:l. 3) The most common clinical symptom or sign was asymptomatic hematuria(84.5%), followed by proteinuria(79.6%), hypertension(46.3%), edema(16.4%) in that order. The patterns of hematuria were mi- croscopic hematuria(49%), gross hematuria(24%), mi- croscopic hematuria with intermittent gross hema- turia(11.5%). 4) On urine analysis, 44.4% of the patients sho- wed proteinuria less than 1.0g/day, and 35.3% showed more than 3.0g/day of proteinuria. Mean serum C3 level was 68.0 ± 17.95mg/dl, and mean IgA level was 294.4±109.69mg/dl. Percent cases excee- ding 350mg/dl of IgA level was 24.8%. Twenty three patients(11.5%) had impaired renal function at intial evaluation. 5) Of the pathologic grading according to Lee et al, the most common findings was grade III(40%), followed by grade II(25%), grade IV(21%), grade I(7%), grade V(7%) in that order. Significant associ- ations were found between pathologic grade, especi- ally grade V, and the followings hypertension, proteinuria, but not hematuria, serum C3 level, serum IgA level, age, sex. 6) One hundred twenty two cases were followed for a mean period of 29 months (0.5-101 months). Of these, 31 cases(25.4%) had progressive disease and 22 cases of these 31 cases progressed to end- stage renal failure. Unfavorable outcome was noted in the presence of hypertension, increased serum creatinine level at discovery, severe proteinuria (proteinuria >3.0g/day), microscopic hematuria. In clinicopathologic analysis, advanced pathologic grade such as diffuse mesangial and epithelial proliferation or severe sclerotic changes was associated with the unfavorable outcome of the disease. In contrast, age, sex, serum IgA level or serum C3 did not appear to be related to the outcome. 7) Antiplatelet agent such as dipyridamole was not effective statistically in preserving renal function, although the mean follow-up creatinine of patients using antiplatelet agent was lower than those without antiplatelet agent. In conclusion, microscopic hematuria, heavy pro- teinuria(proteinuria >3.0g/day), hypertension, increa- sed serum creatinine(Scr >1.7mg/dl) and advanced pathologic grade, especially above grade IV, by Lee et al appeared to be poor prognostic indices of IgA nephropathy.
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