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【文摘发布】FSGS并不是膜性肾病病人肾脏转归的充分预测指标

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楼主 njzjd08
njzjd08
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这个帖子发布于13年零277天前，其中的信息可能已发生改变或有所发展。
Focal segmental glomerulosclerosis is not a sufficient predictor of renal outcome in patients with membranous nephropathy.
Department of Nephrology and Department of Pathology, Radboud University Nijmegen Medical Centre, The Netherlands.
BACKGROUND: The course of idiopathic membranous nephropathy (iMN) is variable in untreated patients. Accurate prediction of renal outcome would allow optimal treatment decisions. We demonstrated that urinary beta2-microglobulin (beta2M) predicted prognosis in iMN with high sensitivity and specificity. It has been suggested that focal segmental glomerulosclerosis (FSGS) is a discriminative parameter with independent prognostic value. METHODS: We selected patients with iMN biopsied between 1988 and 2002. Biopsies were analysed for the presence of FSGS, interstitial fibrosis and vascular lesions. Serum creatinine, creatinine clearance, proteinuria and blood pressure were recorded at baseline. Outcome variables included remission of proteinuria, renal death (RD) defined as serum creatinine >135 mumol/l or increase of serum creatinine of >50%, or end-stage renal disease (ESRD). In a subgroup of patients, urinary beta2-microglobulin (beta2M) was measured. RESULTS: We included 53 patients (33M, 20F). Mean age was 51 years, serum creatinine 99 mumol/l, and proteinuria 7.0 g/10 mmol creatinine. FSGS was present in 22 patients. These patients were characterized by a higher serum creatinine at time of biopsy (P = 0.035), more severe interstitial fibrosis (P = 0.001) and higher stage of membranous nephropathy (P = 0.001). During follow-up 24 patients developed RD, almost equally distributed between patients with and without FSGS. Renal survival was numerically, but not significantly, lower in patients with FSGS. In Cox proportional hazard analysis, only serum creatinine at the time of biopsy was an independent predictor of RD or ESRD (P < 0.001). In patients with known urinary beta2M, there was no significant correlation with FSGS score (P = 0.174). CONCLUSION: FSGS is not an accurate prognostic marker in iMN. Histological scoring of FSGS is inferior to measurement of urinary proteins in predicting renal outcome in iMN.
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2007-04-21 05:42 浏览 : 717 回复 : 3
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本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领
2007-04-21 10:34
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yuj2004
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Focal segmental glomerulosclerosis is not a sufficient predictor of renal outcome in patients with membranous nephropathy
局灶节段性肾小球硬化不是膜性肾病病人肾脏转归的充分预测指标.
BACKGROUND: The course of idiopathic membranous nephropathy (iMN) is variable in untreated patients.
介绍:对于未做治疗的病人,特发性膜性肾病的进展是因人而异的.
Accurate prediction of renal outcome would allow optimal treatment decisions.
肾病转归的精确预测将带来最佳的治疗结论.
We demonstrated that urinary beta2-microglobulin (beta2M) predicted prognosis in iMN with high sensitivity and specificity.
我们发现尿β-2微球蛋白对于预测特发性膜性肾病的预后有很好的灵敏度和特异性 .
It has been suggested that focal segmental glomerulosclerosis (FSGS) is a discriminative parameter with independent prognostic value.
认为局灶节段性肾小球硬化是一个有独立诊断价值的特别参数.
METHODS: We selected patients with iMN biopsied between 1988 and 2002.
方法:我们选择特发性膜性肾病病人做活组织检查(1988年----2002年)
Biopsies were analysed for the presence of FSGS, interstitial fibrosis and vascular lesions.
分析这些病人活组织中的局灶节段性肾小球硬化,间质性纤维化,血管病变的情况.
Serum creatinine, creatinine clearance, proteinuria and blood pressure were recorded at baseline.
血清肌酸酐, 内生肌酐清除率,蛋白尿,血压在基线水平.
Outcome variables included remission of proteinuria, renal death (RD) defined as serum creatinine >135 mumol/l or increase of serum creatinine of >50%, or end-stage renal disease (ESRD).
转归结果包括蛋白尿的减轻,肾衰竭(定义为 血清肌酸酐>135 mumol/l或血清肌酸酐的增加>50%,终末期肾病)
In a subgroup of patients, urinary beta2-microglobulin (beta2M) was measured.
在这些病人中的一小群检测了尿β-2微球蛋白的水平.
RESULTS: We included 53 patients (33M, 20F). Mean age was 51 years, serum creatinine 99 mumol/l, and proteinuria 7.0 g/10 mmol creatinine.
结果:实验包括53个病人(33个男性,20个女性),平均年龄是51岁, 血清肌酸酐99 mumol/l,蛋白尿 7.0 g/10 mmol 肌酸酐.
FSGS was present in 22 patients. These patients were characterized by a higher serum creatinine at time of biopsy (P = 0.035), more severe interstitial fibrosis (P = 0.001) and higher stage of membranous nephropathy (P = 0.001).
有22个病人存在局灶节段性肾小球硬化,这些病人的血清肌酸酐水平,间质纤维化程度,膜性肾病的阶段有时间依赖性( P分别为0.035,0.001,0.001)
During follow-up 24 patients developed RD, almost equally distributed between patients with and without FSGS.
在这24个发展到肾衰竭的随访病人,有和没有局灶节段性肾小球硬化的病人是相当的.
Renal survival was numerically, but not significantly, lower in patients with FSGS.
残余肾功能是存在的,但很少,在有局灶节段性肾小球硬化的病人是更低.
In Cox proportional hazard analysis, only serum creatinine at the time of biopsy was an independent predictor of RD or ESRD (P < 0.001).
在 Cox比例危险分析中,仅仅血清肌酸酐是肾衰竭或终末期肾病的独立预测指标 (P < 0.001).
In patients with known urinary beta2M, there was no significant correlation with FSGS score (P = 0.174).
对于那些有明显β-2微球蛋白尿的病人,和局灶节段性肾小球硬化评分没有明显的相关
CONCLUSION: FSGS is not an accurate prognostic marker in iMN. Histological scoring of FSGS is inferior to measurement of urinary proteins in predicting renal outcome in iMN.
结论:对于特发性膜性肾病,局灶节段性肾小球硬化不是一个精确的预测指标.通过局灶节段性肾小球硬化组织学评分来衡量尿蛋白水平对于预测特发性膜性肾病病人肾脏转归是牵强的.
2007-04-21 22:26
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楼主 njzjd08
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BACKGROUND 背景
optimal treatment decisions 最佳治疗决策
e selected patients with iMN biopsied between 1988 and 2002.
我们选择了1988－2002间活检证实特发性膜性肾病的患者来研究

These patients were characterized by a higher serum creatinine at time of biopsy (P = 0.035), more severe interstitial fibrosis (P = 0.001) and higher stage of membranous nephropathy (P = 0.001).
有22个病人存在局灶节段性肾小球硬化,这些病人在肾活检时有着较高的血清肌酸酐水平,活检间质纤维化程度较重,膜性肾病的处于较高阶段( P分别为0.035,0.001,0.001)
2007-04-23 00:20
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