Renal Prognostic Factors for Clinical Outcome in Pregnant Women with IgA Nephropathy
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概要
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本研究の目的は,IgA腎症を合併した妊娠の予後に影響する腎性因子を検討することである.対象は,妊娠前に腎生検でIgA腎症と診断された10例の女性で,平均年齢は30.5(21～36)歳である.臨床経過から次の2群に分けて検討した.I群(5例)は,妊娠後も血清クレアチニン(Cr)値の有意な上昇を認めなかったグループで,II群(5例)は妊娠後に腎機能が悪化したグループである.血圧,尿蛋白量,血清Cr値,および腎生検所見を比較検討した.I群に比しII群では妊娠中毒症などの母体の合併症が多かった.妊娠前における血清Cr値は,両群で有意差を認めなかったが,妊娠後にはII群で有意な尿蛋白量の増加を認め,拡張期血圧の高値を伴っていた.また,I群に比しII群では半月俸形成率が高く,尿細管間質障害の程度が強かった.これらの結果から,IgA腎症を合併した妊婦は,拡張期血圧のコントロールと腎生検所見に基づいた注意深い経過観察が重要であると考えられた.The present study was designed to determine the renal prognostic factors influencing the clinical outcome of pregnant women with IgA nephropathy (IgAN). The clinical courses of 10 women, ranging in age from 26 to 36 years (average age of 30.5 years) with biopsy-proven IgAN were studied. The patients were divided into two groups on the basis of their renal function outcome: group I consisted of five patients with no changes in renal function during pregnancy, and group II consisted of five patients who experienced a deterioration in renal function as a result of their pregnancy. The patients in group II had a greater incidence of maternal complications than those in group I. The serum creatinine levels before pregnancy were not significantly different in the two groups. However, patients in group II experienced an increase in proteinuria after pregnancy. The increase in proteinuria was associated with an elevated diastolic blood pressure. Histological features, such as crescent formation and tubulo-interstitial injury, were poor prognostic factors of renal function outcome in pregnant women with IgAN. Careful observation of diastolic blood pressure and a knowledge of the underlying histological pattern in IgAN patients may have predictive value in identifying high risk pregnancies.
- 2001-06-25
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