초록 열기/닫기 버튼
목적: 병리학적 소견을 바탕으로 IgA 신증 환자의 예후를예측하고자 여러 분류들이 소개되었다. 최근에 소개된 Oxford분류법과 전자현미경 소견을 이용하여 예후인자와 연관성및 신생존의 예측 능력을 알아보고자 하였다. 방법: 1997년부터 2007년까지 IgA 신증으로 진단된 환자213명을 후향적으로 조사하여 병리의사가 Oxford 분류법과전자현미경 소견을 바탕으로 재분류하고 연령, 성별, 단백뇨, 신기능 저하, 고혈압 등과의 연관성 및 신생존율 분석에적용하였다. 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 tubularatrophy/interstitial fibrosis가 단백뇨의 정도를 잘 반영했을 뿐만 아니라 신기능의 악화를 예측할 수 있는 강력한 평가 항목임을 보여주었다.
Background/Aims: The Oxford classification of immunoglobulin A nephropathy (IgAN) is a pathology-based prognosticclassification system. However, further study is needed to determine its validity. We studied the relationships between the Oxfordclassification and established prognostic factors and renal survival. We also examined associations between electron microscopyfindings and these parameters. Methods: We reviewed and reclassified 213 patients who were diagnosed with IgAN from 1997 to 2007 using the Oxford andWorld Health Organization (WHO) classification systems. The patients were also categorized by a pathologist using electronmicroscopy findings, including foot process fusion, glomerular basement membrane thickness, and electron-dense deposits. Weexamined 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 renalsurvival. 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/creatinineratio increased significantly with the degrees of S (p = 0.036), E (p = 0.0155), and T (p = 0.015). The serum creatinine level wassignificantly higher in patients with T2 than T1 or T0 (p < 0.0001). At the time of biopsy, the degree of tubular atrophy/interstitialfibrosis affected the doubling of serum creatinine or end-stage renal disease. However, the electron microscopy findings did notpredict the renal outcome. Conclusions: Our study suggests that tubular atrophy/interstitial fibrosis is significantly associated with proteinuria and renalprogression in IgAN.
키워드열기/닫기 버튼
IgA nephropathy, Prognosis, Oxford classification, Electron microscopy
