腎機能正常原発性糸球体疾患患者の腎機能に及ぼす運動の影響

Abstract

This study evaluates the effects of exercise on the renal function of 50 patients with primary glomerular diseases (PGD) whose serum creatinine levels were below 0.9mg/dl. Thirty-five of them had IgA nephropathy (IgA-GN), 10 had membranous nephropathy (MN), and five had focal segmental glomerulosclerosis (FGS). The patients with IgA-GN were classified as either mild or moderate mesangial proliferative glomer- ulonephritis group (IgA-GN 1 and IgA-GN 2, respectively). Ten healthy subjects served as controls. Exercise capacity at the anaerobic threshold (AT) and at the end-point of oxygen consumption (⩒ₒ₂peak) was evaluated by analysis of exhaled gas in each breath. The exercise tests were performed on a bicycle ergometer with a work load of AT (Wᴀᴛ) for 10 minutes by all subjects and with two different work loads of AT and 1.3 times AT (Wᴀᴛ₁.₃) for 10 minutes by controls and each of the 10 patients of the two IgA-GN subgroups. In all subjects renal plasma flow (RPF) significantly decreased during exercise in Wᴀᴛ. Only in the IgA-GN2 group glomerular filtration rate (GFR) significantly decreased during exercise in Wᴀᴛ₁.₃, but was unchanged in all other groups during each exercise in Wᴀᴛ and Wᴀᴛ₁.₃. In eight of the patients with PGD urinary protein during exercise in Wᴀᴛ increased by more than 0.8 mg/min compared to before exercise (Group A), and in 11 other patients by less than 0.8mg/min (Group B). GFR was significantly decreased in Group A, but unchanged in Group B for an observation period of three years. These findings suggest that exercise below the level of Wᴀᴛ is suitable activity for patients with IgA-GN 2, MN and FGS, and exercise below the level of Wᴀᴛ₁.₃ is suitable for patients with IgA-GN 1 on a daily basis. However exercise in Wᴀᴛ is excessive for patients with PGD whose urinary protein increases with such exercise.