Kidney Research and Clinical Practice

Korean Society of Nephrology (대한신장학회)
권호 표지

Clinicopathologic Study on Adults Idiopathic Nephrotic Syndrome in Korea

성인 특발성 신증후군의 임상적 고찰 - 단일 기관 성적 -

Sung, Jung-Hoon;Hwang, Eun-Ah;Kwak, Jin-Ho;Jin, Kyu-Bok;Han, Seung-Yeup;Park, Sung-Bae;Kim, Hyun-Chul
성정훈;황은아;곽진호;진규복;한승엽;박성배;김현철

  • Published : 20070100
⟨ Previous Next ⟩

Abstract

Purpose: We examined the clinical characteristics and incidence of adults idiopathic nephrotic syndrome (NS) according to pathologic diagnosis, age, sex. Methods: We retrospectively reviewed the clinical and pathological characteristics of primary glomerular lesions in adults idiopathic NS taken a renal biopsy from 1978 to 2005 at the Dongsan Medical Center. We compared the prevalence of adults idiopathic NS according to the pathologic diagnosis between two time intervals 1978 to 1990 and 1991 to 2005. Results: The patients had mean age of 36.7±16.3 years and male to female ratio was 1.7:1 with male predominance. The frequency of histopathologic diagnoses were minimal change nephrotic syndrome (MCNS) 51.6%, membranous glomerulonephritis (MGN) 21.3%, focal segmental glomerulosclerosis (FSGS) 12.1%, IgA nephropathy 9.1%, membranoproliferative glomerulonephritis (MPGN) 4.2% in decreasing order of frequency. The mean age was youngest in MCNS (32.9±15.1) and oldest in MGN (46.2±16.6). Between 1978 to 1990 period and 1991 to 2005 period, the prevalence of MGN was significantly increased, whereas the prevalence of MPGN was decreased significantly. The prevalence of MCNS had a tendency to decrease and that of IgA nephropathy had a tendency to increase, however, both didn't reach statistical significance. The incidence of FSGS didn't show a significant change during the both study periods. Conclusion: MCNS was the most common disease among adults idiopathic NS. MGN was the most frequent etiology in patients older than 45 years. The incidence of MGN was increased over the 28- year period, and that of MPGN decreased significantly. There was no change in the frequency of FSGS.

목 적: 성인 특발성 신증후군 환자의 남녀별, 연령별 및 병리조직학적 유형에 따른 임상상과 조사 시기에 따른 원인 질환의 발생 비율의 변화에 대해 조사하고자 하였다. 방 법: 1978년부터 2005년까지 계명의대 동산병원 내과에 입원하여 신생검을 통해 특발성 신증후군으로 진단받은 15세 이상의 성인 환자 823 예를 대상으로 병리조직학적 유형별 비율, 그 유형에 따른 임상상, 관찰 시기에 따른 원인 신질환 비율의 변화를 후향적으로 분석 비교하였다. 결 과: 대상 환자의 수는 823명이었고 평균 연령은 36.7세, 남녀비는 1.7:1로 남자에서 많았다. 병리조직학적 유형은 전체적으로 미세 변화형 신증후군이 51.6%로 가장 많았고, 그 다음이 막성 신염이 21.3%, 초점성 분절성 사구체경화증 12.1%, IgA 신병증 9.1%, 막증식성 사구체신염 3.8% 순이었다. 45세 이하에서는 미세 변화형 신증후군이 가장 흔한 병리조직학적 유형이었으나 45세 이상 군에서는 막성 신염의 비율이 높았다. 1978-1990년과 1991-2005년까지의 두 기간으로 구분했을 때 미세 변화형 신증후군은 다소 감소하는 경향을, 막성 신염은 유의하게 증가한 반면, 막증식성 사구체신염은 유의하게 감소하였다. IgA 신병증은 다소 증가하는 추세를 보였고, 초점성 분절성 사구체경화증은 유의한 변화가 없었다. 결 론: 성인 특발성 신증후군의 원인 질환으로 전체적으로 미세 변화형 신증후군이 가장 많았다. 연령별로는 45세 이하에서는 미세 변화형 신증후군이, 45세 이상에서는 막성 신염의 비율이 가장 높았다. 과거에 비해서 최근에 막성 신염의 비율은 유의하게 증가한 반면 막증식성 사구체신염의 비율은 유의하게 감소하였다.

Keywords

References

  1. Iversen P, Brun C: Aspiration biopsy of the kidney. Am J Med 11:324-330, 1951 https://doi.org/10.1016/0002-9343(51)90169-6
  2. Kark RM, Muehrcke RC, Pollak VE, Pirani CL, Kiefer JH: An analysis of five hundred percutaneous renal biopsies. AMA Arch Intern Med 101:439-451, 1958 https://doi.org/10.1001/archinte.1958.00260140271038
  3. Sharples PM, Poulton J, White RH: Steroid responsive nephrotic syndrome is more common in Asians. Arch Dis Child 60:1014-1017, 1985 https://doi.org/10.1136/adc.60.11.1014
  4. Bonilla-Felix M, Parra C, Dajani T, Ferris M, Swinford RD, Portman RJ, Verani R: Changing patterns in the histopathology of idiopathic nephrotic syndrome in children. Kidney Int 55:1885-1890, 1999 https://doi.org/10.1046/j.1523-1755.1999.00408.x
  5. Braden GL, Mulhern JG, O'Shea MH, Nash SV, Ucci AA Jr., Germain MJ: Changing incidence of glomerular diseases in adults. Am J Kidney Dis 35:878-883, 2000 https://doi.org/10.1016/S0272-6386(00)70258-7
  6. Korbet SM, Genchi RM, Borok RZ, Schwartz MM:The racial prevalence of glomerular lesions in nephrotic adults. Am J Kidney Dis 27:647-651, 1996 https://doi.org/10.1016/S0272-6386(96)90098-0
  7. Ingulli E, Tejani A: Racial differences in the incidence and renal outcome of idiopathic focal segmental glomerulosclerosis in children. Pediatr Nephrol 5:393-397, 1991 https://doi.org/10.1007/BF01453661
  8. Pontier PJ, Patel TG: Racial differences in the prevalence and presentation of glomerular disease in adults. Clin Nephrol 42:79-84, 1994
  9. Park JS, Lee SR: Clinical observation on adults idiopathic nephrotic syndrome. Kyungpook Univ Med J 21:646-655, 1980
  10. Cho KH, Park SK, Kwang SK: Clinical studies on the primary adults nephrotic syndrome in Korea. Korean J Med 33:147-152, 1987
  11. Yu SH, Kang JH, Choi JS, Kim WD, Lee JS, Kim DJ:Clinical studies on the primary nephrotic syndrome of Korean adults. Korean J Med 18:297-309, 1975
  12. Kim HC, Choi CO, Chung TH, Seo YS, Park SB, Park KK, Lee SS: Clinical studies on the adult idiopathic nephrotic syndrome in Korea. Korean J Med 40:516-525, 1991
  13. Kim KH, Kwon HC, Kim MB, An WS, Gam DH, Kim SG, Kim SE, Kim JS: Analysis of biopsied cases in patients with glomerular diseas. Korean J Med 49:674-682, 1995
  14. Oh KH, Ahn CR, Yang JS, Hwang DY, Han JS, Kim SG, Lee JS, Lee HS: Clinicopathological study on adult nephrotic syndrome. Korean J Nephrol 16:254-265, 1997
  15. Churg J, Sobin HJ: Classification of glomerular diseases. In Renal Disease. Classification and Atlas of Glomerular Disease. Igaku-Shion, Tokyo-New York 1-19, 1982
  16. Covic A, Schiller A, Volovat C, Gluhovschi G, Gusbeth-Tatomir P, Petrica L, Caruntu ID, Bozdog G, Velciov S, Trandafirescu V, Bob F, Cluhovschi C: Epidemiology of renal disease in Romania: a 10 year review of two regional renal biopsy databases. Nephrol Dial Transplant 21:419-424, 2006 https://doi.org/10.1093/ndt/gfi207
  17. Simon P, Ramee MP, Autuly V, Laruelle E, Charasse C, Cam G, Ang KS: Epidemiology of primary glomerular diseases in a French region. Variations according to period and age. Kidney Int 46:1192-1198, 1994 https://doi.org/10.1038/ki.1994.384
  18. Schena FP: Survey of the Italian registry of renal biopsies. Frequency of the renal diseases for 7 consecutive years. The Italian Group of Renal Immunopathology. Nephrol Dial Transplant 12:418-426, 1997 https://doi.org/10.1093/ndt/12.3.418
  19. Tiebosch AT, Wolters J, Frederik PF, van der Wiel TW, Zeppenfeldt E, van Breda Vriesman PJ: Epidemiology of idiopathic glomerular disease : A prospective study. Kidney Int 32:112-116, 1987 https://doi.org/10.1038/ki.1987.179
  20. Choi IJ, Jeong HJ, Han DS, Lee JS, Choi KH, Kang SW, Ha SK, Lee HY, Kim PK: An analysis of 4,514 cases of renal biopsy in Korea. Yonsei Med J 42: 247- 254, 2001 https://doi.org/10.3349/ymj.2001.42.2.247
  21. Feehally J, Kendell NP, Swift PG, Walls J: High incidence of minimal change nephrotic syndrome in Asians. Arch Dis Child 60:1018 1020, 1985
  22. Hirayama K, Koyama A: Epidemiology of Nephrotic Syndrome. Nippon Rinsho 62:1785-1793, 2004
  23. Huang JJ, Hsu SC, Chen FF, Sung JM, Tseng CC, Wang MC: Adult-onset minimal change disease among Taiwanese: clinical features, therapeutic response, and prognosis Am J Nephrol 21:28-34, 2001 https://doi.org/10.1159/000046215
  24. Woo KT, Chiang GS, Pall A, Tan PH, Lau YK, Chin YM: The changing pattern of glomerulonephritis in Singapore over the past two decades. Clin Nephrol 52:96-102, 1999
  25. Date A, Raghavan R, John TJ, Richard J, Kirubakaran MG, Shastry JC: Renal disease in adult Indians: a clinicopathological study of 2827 patients. Q J Med 64:729-737, 1987
  26. Fujimoto S, Yamamoto Y, Hisanaga S, Morita S, Eto T, Tanaka K: Minimal change nephrotic syndrome in adults: response to corticosteroid therapy and frequency of relapse. Am J Kidney Dis 17:687-692, 1991 https://doi.org/10.1016/S0272-6386(12)80353-2
  27. Stratta P, Segoloni GP, Canavese C, Sandri L, Mazzucco G, Roccatello D, Manganaro M, Vercellone A: Incidence of biopsy-proven primary glomerulonephritis in an Italian province. Am J Kidney Dis 27:631-639, 1996 https://doi.org/10.1016/S0272-6386(96)90096-7
  28. Haas M, Meehan SM, Karrison TG, Spargo BH:Changing Etiologies of Unexplained Adult Nephrotic Syndrome: A Comparison of Renal Biopsy Findings From 1976-1979 and 1995-1997. Am J Kidney Dis 30:621-631, 1997 https://doi.org/10.1016/S0272-6386(97)90485-6
  29. Simon P, Ramee MP, Boulahrouz R, Stanescu C, Charasse C, Ang KS, Leonetti F, Cam G, Laruelle E, Autuly V, Rioux N: Epidemiologic data of primary glomerular diseases in western France. Kidney Int 66:905-908, 2004 https://doi.org/10.1111/j.1523-1755.2004.00834.x
  30. Kim YS, Suh WK, Lee TW, Ihm CG, Kim MJ: Clinical characteristics and therapeutic response of adult onset minimal change disease. Korean J Nephrol 6:276-281, 1987
  31. Park KT, Park HS, Jean KC, Lee SE, Kwon H, Kim KH: Characteristics of the laboratory findings of idiopathic minimal change nephrotic syndrome in adults. Korean J Med 37:195-203, 1989
  32. Nolasco F, Cameron JS, Heywood EF, Hicks J, Ogg C, Williams DG: Adult-onset minimal change nephrotic syndrome: a long-term follow-up. Kidney Int 29:1215 -1223, 1986 https://doi.org/10.1038/ki.1986.130
  33. Rychlik I, Jancova E, Tesar V, Kolsky A, Lacha J, Stejskal J, Stejskalova A, Dusek J, Herout V: The Czech registry of renal biopsies. Occurrence of renal diseases in the years 1994-2000. Nephrol Dial Transplant 19:3040-3049, 2004 https://doi.org/10.1093/ndt/gfh521
  34. Haas M, Spargo BH, Coventry S: Increasing incidence of focal-segmental glomerulosclerosis among adult nephropathies: a 20-year renal biopsy study. Am J Kidney Dis 26:740-750, 1995 https://doi.org/10.1016/0272-6386(95)90437-9
  35. D'Agati V: The many masks of focal segmental glomerulosclerosis. Kidney Int 46:1223-1241, 1994 https://doi.org/10.1038/ki.1994.388
  36. Barbiano di Belgiojoso G, Baroni M, Pagliari B, Lavagni MG, Porri MT, Banfi G, Colasanti G, Confalonieri R: Is membranoproliferative glomerulonephritis really decreasing? A multicentre study of 1,548 cases of primary glomerulonephritis. Nephron 40:380-381, 1985 https://doi.org/10.1159/000183500
  37. Progressively decreasing incidence of membranoproliferative glomerulonephritis in Spanish adult population. A multicentre study of 8,545 cases of primary glomerulonephritis. Study Group of the Spanish Society of Nephrology. Nephron 52:370-371, 1989 https://doi.org/10.1159/000185684