IgA нефропатия: особенности клинического течения и прогноз

IgA нефропатия (IgAН), впервые описанная в 1968 году, является самым часто встречающимся в мире первичным гломерулонефритом. Распространенность заболевания наиболее высока в Азии по сравнению с Европой и Северной Америкой; при этом допускается возможность гиподиагностики в таких регионах, как Африка.

Дебютируя, как правило, у пациентов молодого возраста, она становится одной из наиболее важных причин развития терминальной стадии хронической болезни почек, требующей применения заместительной почечной терапии. В то же время, недавние исследования указывают на рост заболеваемости среди пожилых людей, часто с более тяжелыми исходами.

Течение и исход заболевания в настоящее время трудно прогнозируем в связи с выраженным полиморфизмом клинических проявлений и морфологической картины, что, по-видимому, связано с широким спектром возможных вариантов этиопатогенеза. В представленном обзоре литературы рассматриваются современные подходы к оценке клинических симптомов и биомаркеров в аспекте их связи с патоморфологическими чертами и прогнозом IgAН. В течение последних лет выраженная протеинурия признавалась фактически единственным предиктором неблагоприятного исхода и показанием к активному лечению. Однако относительно недавно были получены данные, свидетельствующие о значимости протеинурии любого уровня, а также стабильной микрогематурии для прогноза IgAН, что представляется серьезным основанием для изменения парадигмы терапии заболевания. Отражены две принципиально разные позиции в давней, но продолжающейся до настоящего времени, дискуссии в отношении прогностической роли макрогематурии. В обзоре также обсуждается значение нефротического синдрома в отношении прогноза в зависимости от специфических гистологических паттернов, такими как IgAН – болезнь минимальных изменений или эндокапиллярная пролиферация. На основе литературных материалов анализируются клинические варианты течения IgAН и их связь с исходом болезни. Представлены первые результаты применения кластерного анализа, позволившего выявить отдельные фенотипы заболевания с разным риском прогрессирования и ответом на лечение.

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