성인 특발성 신증후군의 임상적 고찰 - 단일 기관 성적 - = Clinicopathologic Study on Adults Idiopathic Nephrotic Syndrome in Korea

다국어 초록 (Multilingual 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.

국문 초록 (Abstract)

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.

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