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Original Article
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Korean J Med. 2015;88(4):397-405. Published online April 1, 2015.
DOI: https://doi.org/10.3904/kjm.2015.88.4.397
- IgA 신증 환자의 병리소견과 임상경과
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이준영1, 양재원1, 김재석1, 김영섭1, 박현철1, 채문희1, 최승옥1, 엄민섭2, 한병근1
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1연세대학교 원주의과대학 내과학교실
2연세대학교 원주의과대학 병리학교실
- Pathology and Renal Outcome of IgA Nephropathy
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Jun Young Lee1, Jae Won Yang1, Jae Seok Kim1, Young Sub Kim1, Hyeoncheol Park1, Moon Hee Chae1, Seung Ok Choi1, Minseob Eom2, Byoung Geun Han1
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1Departments of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
2Departments of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
- Corresponding author: Byoung Geun Han ,Tel: +82-33-741-0509, Fax: +82-33-731-5884, Email: neptune@yonsei.ac.kr
- Received: August 6, 2014; Revised: August 20, 2014 Accepted: October 16, 2014.
- 목적: 병리학적 소견을 바탕으로 IgA 신증 환자의 예후를 예측하고자 여러 분류들이 소개되었다. 최근에 소개된 Oxford 분류법과 전자현미경 소견을 이용하여 예후인자와 연관성 및 신생존의 예측 능력을 알아보고자 하였다.
방법: 1997년부터 2007년까지 IgA 신증으로 진단된 환자 213명을 후향적으로 조사하여 병리의사가 Oxford 분류법과 전자현미경 소견을 바탕으로 재분류하고 연령, 성별, 단백뇨, 신기능 저하, 고혈압 등과의 연관성 및 신생존율 분석에 적용하였다.
결과: eGFR은 Oxford 분류법의 M, S, E, T 모든 항목과 의미 있는 연관성을 보여 주었고 24시간 소변 단백/크레아티닌비는 S, E, T 모든 항목과 의미 있는 연관성을 보여 주었다. T 항목만이 신생존율과 통계적으로 의미가 있었으며 전자현미경 소견은 신생존율을 예측하는 능력은 보이지 않았다.
결론: 본 연구에서는 Oxford 분류법의 T 항목인 tubular atrophy/interstitial fibrosis가 단백뇨의 정도를 잘 반영했을 뿐만 아니라 신기능의 악화를 예측할 수 있는 강력한 평가 항목임을 보여주었다.
߽ɾ :IgA 신증; 예후; Oxford 분류법; 전자현미경
- Abstract
- Background/Aims
The Oxford classification of immunoglobulin A nephropathy (IgAN) is a pathology-based prognostic classification system. However, further study is needed to determine its validity. We studied the relationships between the Oxford classification and established prognostic factors and renal survival. We also examined associations between electron microscopy findings and these parameters.
Methods
We reviewed and reclassified 213 patients who were diagnosed with IgAN from 1997 to 2007 using the Oxford and World Health Organization (WHO) classification systems. The patients were also categorized by a pathologist using electron microscopy findings, including foot process fusion, glomerular basement membrane thickness, and electron-dense deposits. We examined the correlations between light and electron microscopy data and known prognostic factors (e.g., age, sex, proteinuria, serum creatinine, estimated glomerular filtration rate [eGFR], and blood pressure). The same procedure was applied to renal survival.
Results
Patient age increased with the grades of segmental sclerosis (S) and tubular atrophy/interstitial fibrosis (T) (p < 0.05). eGFR decreased significantly with increasing mesangial hypercellularity (M) (p = 0.0034), S (p = 0.0003), endocapillary hypercellularity (E) (p = 0.0411), and T (p < 0.0001). MSET differed significantly by sex (p < 0.0001). The 24-h urine protein/creatinine ratio increased significantly with the degrees of S (p = 0.036), E (p = 0.0155), and T (p = 0.015). The serum creatinine level was significantly higher in patients with T2 than T1 or T0 (p < 0.0001). At the time of biopsy, the degree of tubular atrophy/interstitial fibrosis affected the doubling of serum creatinine or end-stage renal disease. However, the electron microscopy findings did not predict the renal outcome.
Conclusions
Our study suggests that tubular atrophy/interstitial fibrosis is significantly associated with proteinuria and renal progression in IgAN.
Keywords :IgA nephropathy, Prognosis, Oxford classification, Electron microscopy
