Membranoproliferative glomerulonephritis in Russian population
- 作者: Dobronravov V1, Smirnov A1
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隶属关系:
- Research Institute of Nephrology, I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation
- 期: 卷 90, 编号 12 (2018)
- 页面: 39-47
- 栏目: Editorial
- URL: https://journals.rcsi.science/0040-3660/article/view/32885
- DOI: https://doi.org/10.26442/00403660.2018.12.000007
- ID: 32885
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Aim. Analysis of etiology, clinical and morphological manifestations, approaches to therapy and prognosis of membranoproliferative glomerulonephritis (MPGN). Materials and methods. Cases of MPGN were retrospectively identified in the period 2000-2017 with subsequent analysis of etiology, clinical data and morphology (including deposits of immunoglobulins (Ig) and C3 complement fractions). The achievement of complete and partial remissions (PR, CR), overall survival, progression (by composite endpoint: decrease in the estimated GFR (eGFR) ≥50% from the baseline or eGFR <15 ml/min/1.73 m2 or the onset of dialysis). Results and discussion. 214 cases of MPGN entered the study with the average age of 44±16 years. Most patients had nephrotic syndrome and significant hematuria. In 58.4% of cases, eGFR was <60 mL/min/1.73 m2, and every fifth patient had CKD 4 or 5 stages. The prevalence of MPGN among all biopsy-confirmed glomerulopathies was 9.3%. Idiopathic MPGN (iMPGN) was detected in 30.4% of cases, secondary MSGN (sMPGN) - in 69.6% (autoimmune diseases - 34.1%, infectious diseases - 16.4%, monoclonal gammopathies - 9.3%, complement-mediated damage - 9.8%). Ig+C3+MPGN was mainly associated with autoimmune diseases and infections; C3-glomerulopathy or thrombotic microangiopathy were most often causes of Ig-C3+MPGN; Ig-C3-/Ig+C3-MPGN had heterogeneous etiology. The median follow-up period was 28 [7; 37] months. The 10-year total cumulative patient and renal survival rates were 71 and 50%, respectively (without differences between sMPGN and iMPGN). The frequency of the PR/CR was 50% (iMPGN - 46.2%, sMPGN - 51.3%) depending on the etiology of the MPGN (p=0.049). The cumulative 10-year progression-free renal survival was nearly 100% in cases with PR/CR and 0% in non-responders. Conclusion. MPGN is a severe variant of glomerular damage with a heterogeneous etiological structure and an unfavorable prognosis. Targeted clinical and morphological diagnostics of MPGN allows to identify the cause of the disease in most cases. This approach is reliable for the adequate treatment choice and improvement of outcomes in MPGN.
作者简介
V Dobronravov
Research Institute of Nephrology, I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federation
Email: dobronravov@nephrolog.ru
д.м.н., проф. каф. пропедевтики внутренних болезней, зам. директора по научной работе НИИ нефрологии Первого СПбГМУ им. акад. И.П. Павлова Saint Petersburg, Russia
A Smirnov
Research Institute of Nephrology, I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Health of the Russian Federationд.м.н., проф., зав. каф. пропедевтики внутренних болезней, директор НИИ нефрологии Первого СПбГМУ им. акад. И.П. Павлова Saint Petersburg, Russia
参考
- Sethi S, Fervenza F.C. Membranoproliferative glomerulonephritis: Pathogenetic heterogeneity and proposal for a new classification. Semin Nephrol. 2011;31:341-8. doi: 10.1016/j.semnephrol.2011.06.005
- Cook H.T, Pickering M.C. Histopathology of MPGN and C3 glomerulopathies. Nat Rev Nephrol. 2015;11(1):14-22. doi: 10.1038/nrneph.2014.217
- Kidney Disease: Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group: KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney Int Suppl. 2012;2:139-274. doi: 10.1038/kisup.2012.1
- Смирнов А.В., Добронравов В.А., Сиповский В.Г., Трофименко И.И., Пирожков И.А., Каюков И.Г., Лебедев К.И. Клинические рекомендации по диагностике, лечению и прогнозу мембранопролиферативного гломерулонефрита. Нефрология. 2014;18(6):82-93 http://journal.nephrolog.ru/jour/article/view/63
- Levey A.S, Stevens L.A, Schmid C.H, Zhang Y.L, Castro A.F, Feldman H.I, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604-12. doi: 10.7326/0003-4819-150-9-200905050-00006
- Nargund P, Kambham N, Mehta K, Lafayette R.A. Clinicopathological features of membranoproliferative glomerulonephritis under a new classification. Clin Nephrol. 2015;84(6):323-30. doi: 10.5414/cn108619
- Pavinic J, Miglinas M. The incidence of possible causes of membranoproliferative glomerulonephritis: a single - center experience. Hippokratia. 2015;19(4):314-8.
- Nakagawa N, Hasebe N, Hattori M, Nagata M, Yokoyama H, Sato H, et al. Clinical features and pathogenesis of membranoproliferative glomerulonephritis: a nationwide analysis of the Japan renal biopsy registry from 2007 to 2015. Clin Exp Nephrol. 2017. doi: 10.1007/s10157-017-1513-7
- Anders H.J, Fogo A.B. Immunopathology of lupus nephritis. Semin Immunopathol. 2014;36(4):443-59. doi: 10.1007/s00281-013-0413-5
- Haas M. Histologic subclassification of IgA nephropathy: A clinicopathologic study of 244 cases. Am J Kidney Dis. 1997;29:829-42. doi: 10.1016/s0272-6386(97)90456-x
- Gaut J.P, Liapis H. IgA dominant post - infectious glomerulonephritis: Pathology and insights into disease mechanisms. Diagn Histopathol. 2013;19:175-81. doi: 10.1016/j.mpdhp.2013.02.005
- Kurosu A, Oka N, Hamaguchi T, Yoshikawa N, Joh K. Infantile immunoglobulin A nephropathy showing features of membranoproliferative glomerulonephritis. Tohoku J Exp Med. 2012;228:253-8. doi: 10.1620/tjem.228.253
- Ferrario G, Palazzi P, Torri Tarelli L, Volpi A, Meroni M, Giordano F, et al. Membranoproliferative glomerulonephritis with IgA deposits in patients with alcoholic cirrhosis. Pathologica. 1986;78:469-78.
- Trimarchi H, Barratt J, Cattran D.C, Cook H.T, Coppo R, Haas M, et al. Oxford Classification of IgA nephropathy 2016: an update from the IgA Nephropathy Classification Working Group. Kidney Int. 2017;91(5):1014-21. doi: 10.1016/j.kint.2017.02.003
- Добронравов В.А., Дунаева Н.В. Поражение почек и хронический вирусный гепатит С. Нефрология. 2008;12(4):9-19 https://cyberleninka.ru/article/n/porazhenie-pochek-i-hronicheskiy-virusnyy-gepatit-s
- Sethi S, Zand L, Leung N, Smith R.J, Jevremonic D, Herrmann S.S, Fervenza F.C. Membranoproliferative glomerulonephritis secondary to monoclonal gammopathy. Clin J Am Soc Nephrol. 2010;5(5):770-82. doi: 10.2215/CJN.06760909
- Pickering M.C, D’Agati V.D, Nester C.M, Smith R.J, Haas M, Appel G.B, et al. C3 glomerulopathy: Consensus report. Kidney Int. 2013;84:1079-89. doi: 10.1038/ki.2013.377
- Doshi M, Lahoti A, Danesh F.R, Batuman V, Sanders P.W. American Society of Nephrology Onco-Nephrology Forum. Paraprotein-Related Kidney Disease: Kidney Injury from Paraproteins-What Determines the Site of Injury? Clin J Am Soc Nephrol. 2016;11(12):2288-94. doi: 10.2215/CJN.02560316
- Foltyn Zadura A, Zipfel P.F, Bokarewa M.I, Sturfelt G, Jönsen A, Nilsson S.C, et al. Factor H autoantibodies and deletion of Complement Factor H-Related protein-1 in rheumatic diseases in comparison to atypical hemolytic uremic syndrome. Arthritis Res Ther. 2012;14(4):R185. doi: 10.1186/ar4016
- Iatropoulos P, Noris M, Mele C, Piras R, Valoti E, Bresin E, et al. Complement gene variants determine the risk of immunoglobulin - associated MPGN and C3 glomerulopathy and predict long - term renal outcome. Mol Immunol. 2016;71:131-42. doi: 10.1016/j.molimm.2016.01.010
- Marinozzi M.C, Roumenina L.T, Chauvet S, Hertig A, Bertrand D, Olagne J, et al. Anti-Factor B and Anti-C3b Autoantibodies in C3 Glomerulopathy and Ig-Associated Membranoproliferative GN. J Am Soc Nephrol. 2017;28(5):1603-13. doi: 10.1681/ASN.2016030343
- Iatropoulos P, Daina E, Curreri M, Piras R, Valoti E, Mele C, et al. Cluster Analysis Identifies Distinct Pathogenetic Patterns in C3 Glomerulopathies/Immune Complex-Mediated Membranoproliferative GN. J Am Soc Nephrol. 2018;29(1):283-94. doi: 10.1681/ASN.2017030258
- Hou J, Markowitz G.S, Bomback A.S, Appel G.B, Herlitz L.C, Barry Stokes M, d'Agati V.D. Toward a working definition of C3 glomerulopathy by immunofluorescence. Kidney Int. 2014;85(2):450-6. doi: 10.1038/ki.2013.340
- Юрова В.А., Козловская Н.Л. Мембранопролиферативный гломерулонефрит: новое в классификации и патогенезе. Клиническая нефрология. 2016;(3-4):4-10 https://nephrologyjournal.ru/ru/archive/article/33647
- Palmer S.C, Tunnicliffe D.J, Singh-Grewal D, Mavridis D, Tonelli M, Johnson D.W, et al. Induction and Maintenance Immunosuppression Treatment of Proliferative Lupus Nephritis: A Network Meta - analysis of Randomized Trials. Am J Kidney Dis. 2017;70(3):324-36. doi: 10.1053/j.ajkd.2016.12.008
- Lorenz G, Desai J, Anders H.J. Lupus nephritis: update on mechanisms of systemic autoimmunity and kidney immunopathology. Curr Opin Nephrol Hypertens. 2014;23(3):211-7. doi: 10.1097/01.mnh.0000444816.57378.21
- Touma Z, Gladman D.D. Current and future therapies for SLE: obstacles and recommendations for the development of novel treatments. Lupus Sci Med. 2017;4(1):e000239. doi: 10.1136/lupus-2017-000239
- Шилов Е.М., Бобкова И.Н., Колина И.Б., Камышова Е.С. Клинические рекомендации по диагностике и лечению IgА-нефропатии. Нефрология. 2015;19(6):83-92 http://journal.nephrolog.ru/jour/article/view/146
- Shao X, Li B, Cao L, Liang L, Yang J, Wang Y, et al. Evaluation of crescent formation as a predictive marker in immunoglobulin A nephropathy: a systematic review and meta - analysis. Oncotarget. 2017;8(28):46436-48. doi: 10.18632/oncotarget.17502
- Tam F.W.K, Pusey C.D. TESTING Corticosteroids in IgA Nephropathy: A Continuing Challenge. Clin J Am Soc Nephrol. 2018;13(1):158-60. doi: 10.2215/CJN.10560917
- Johnson R.J, Shimada M. Contemporary Management of Hepatitis C in Patients with CKD. Clin J Am Soc Nephrol. 2017;12(10):1563-5. doi: 10.2215/CJN.07620717
- De Vita S, Quartuccio L, Isola M, Mazzaro C, Scaini P, Lenzi M, et al. A randomized controlled trial of rituximab for the treatment of severe cryoglobulinemic vasculitis. Arthritis Rheum. 2012;64(3):843-53. doi: 10.1002/art.34331
- Козловская Л.В., Рамеев В.В., Когарко И.Н., Гордовская Н.Б., Чеботарева Н.В., Андросова Т.В. и др. Поражения почек, ассоциированные с моноклональной гаммапатией неопределенного значения: клинические формы, механизмы развития, подходы к лечению. Клиническая медицина. 2016;94(12):892-901 doi: 10.18821/0023-2149-2016-94-12-892-901
- Bridoux F, Leung N, Hutchison C.A, Touchard G, Sethi S, Fermand J.P, et al. International Kidney and Monoclonal Gammopathy Research Group. Diagnosis of monoclonal gammopathy of renal significance. Kidney Int. 2015;87(4):698-711. doi: 10.1038/ki.2014.408
- Добронравов В.А. Прогностические факторы, определяющие развитие хронической почечной недостаточности при мембранозно - пролиферативном гломерулонефрите. Клиническая медицина. 1996;74(7):29-33.
- Bohle A, Wehrmann M, Bogenschütz O, Batz C, Vogl W, Schmitt H, et al. The long - term prognosis of the primary glomerulonephritides. A morphological and clinical analysis of 1747 cases. Pathol Res Pract. 1992;188(7):908-24. doi: 10.1016/s0344-0338(11)80252-9
- Goodship T.H, Cook H.T, Fakhouri F, Fervenza F.C, Frémeaux-Bacchi V, Kavanagh D, et al. Atypical hemolytic uremic syndrome and C3 glomerulopathy: conclusions from a "Kidney Disease: Improving Global Outcomes" (KDIGO) Controversies Conference. Kidney Int. 2017;91(3):539-51. doi: 10.1016/j.kint.2016.10.005
- Reddy Y.N, Siedlecki A.M, Francis J.M. Breaking down the complement system: a review and update on novel therapies. Curr Opin Nephrol Hypertens. 2017;26(2):123-8. doi: 10.1097/MNH.0000000000000305