IgAN374.xls

In this study, baseline
demographics , clinical and pathology data were collected for all patients
during renal biopsies, including age, gender, mean arterial pressure (MAP)
defined as diastolic pressure plus one-third of the pulse pressure, 24-hour
protein excretion and estimated glomerular filtration rate (eGFR) calculated by
the Chronic Kidney Disease Epidemiology (CKD-EPI) Collaboration equation.
Regardless of the duration and dose, the type of immunosuppression or renin-angiotensin-aldosterone system (RAAS) blockades
therapy that the patient received was recorded. Immunosuppression
was defined as treatment with corticosteroids and/or corticosteroid-sparing
agents (including cyclophosphamide, azathioprine, mycophenolate, cyclosporine
or tacrolimus). RAAS blockades included any exposure to angiotensin-converting
enzyme inhibitor and/or angiotensin receptor blocker after biopsy. The
updated Oxford Classification(MEST-C) for IgAN was applied in this study[5]. Renal biopsy samples from all patients were examined
by pathologist and nephrologist. The crescent is subdivided according to the
volume, composition and proportion of the crescent. The volume of the crescent
body is defined as the large crescent body accounting for 50% or more of the
renal sac volume and the small crescent body accounting for 50% or less of the
renal sac volume. The components of crescent body can be divided into cellular
crescent, cellular fibrous crescent and fibrous crescent. The cellular crescent
consists of > 75% cells and < 25% fibrous matrix. The fibrous
cellular crescent consists of 25%-75% of the cells and the remaining
fibrous matrix. Extracapillary fibrosis of fibrous crescents consists of >
75% matrix and < 25% cells. The crescent ratio is defined as the proportion
of the number of glomeruli with crescents in the total number of glomeruli, and
the cell / fibrous cell / fibrous crescent is evaluated according to the
relative ratio. ESRD was defined as eGFR<15 mL/min/1.73 m2 for more than 3
months or initiation of dialysis or transplantation. In this study, we defined clinical outcome: the combined event (Doubling of
serum creatinine, 50% reduction in eGFR, 15% reduction in eGFR within 1 year,
30% reduction in eGFR within 2 year,
ESRD or death ) after diagnostic kidney biopsy.<br>
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本研究收集了所有接受肾活检患者的基线人口学、临床及病理学资料，包括年龄、性别、平均动脉压（mean arterial pressure, MAP），其定义为舒张压加上三分之一的脉压、24小时尿蛋白排泄量，以及采用慢性肾脏病流行病学合作组（Chronic Kidney Disease Epidemiology Collaboration, CKD-EPI）公式计算的估算肾小球滤过率（estimated glomerular filtration rate, eGFR）。
无论治疗疗程与剂量如何，均记录了患者所接受的免疫抑制治疗类型及肾素-血管紧张素-醛固酮系统（renin-angiotensin-aldosterone system, RAAS）阻断治疗方案。其中，免疫抑制治疗定义为使用糖皮质激素及/或糖皮质激素节约剂（包括环磷酰胺、硫唑嘌呤、霉酚酸酯、环孢素或他克莫司）。RAAS阻断治疗包括肾活检后暴露于任何血管紧张素转换酶抑制剂及/或血管紧张素Ⅱ受体拮抗剂的情况。
本研究采用了IgA肾病牛津分型（Oxford Classification(MEST-C)）[5]。所有患者的肾活检样本均由病理学家及肾脏病学家进行阅片评估。新月体根据其体积、组成成分及占比进行细分：新月体体积以占肾囊体积50%及以上者为大新月体，占比50%及以下者为小新月体；新月体组成可分为细胞性新月体、细胞纤维性新月体及纤维性新月体。细胞性新月体指细胞占比＞75%、纤维基质占比＜25%的新月体；细胞纤维性新月体指细胞占比为25%~75%、其余成分为纤维基质的新月体；纤维性新月体的毛细血管外纤维化指基质占比＞75%、细胞占比＜25%的病变。新月体比例定义为存在新月体的肾小球数量占总肾小球数量的比例，并根据细胞/细胞纤维/纤维性新月体的相对占比进行评估。
终末期肾病（end-stage renal disease, ESRD）定义为eGFR＜15 mL/min/1.73 m²且持续超过3个月，或开始透析治疗、肾移植。本研究定义的临床结局为诊断性肾活检后出现的复合事件：血清肌酐翻倍、eGFR下降50%、1年内eGFR下降15%、2年内eGFR下降30%，或发生ESRD、死亡。