Immunosuppressive treatment of idiopathic focal segmental glomerulosclerosis: A five-year follow-up study
Immunosuppressive treatment of idiopathic focal segmental glomerulosclerosis: A five-year follow-up study
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DOI：
10.1159/000093993
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发表时间：
2006-01-01
影响因子：
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通讯作者：
Brown, Colin B.
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文献类型：
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作者：
Goumenos, Dirnitrios S.;Tsagalis, George;Brown, Colin B.
背景/目的：局灶节段性肾小球硬化症（FSGS）是一种常见的肾小球疾病，可导致慢性肾功能衰竭。肾病 FSGS 患者已使用多种治疗方案。研究了单独使用泼尼松龙或其与硫唑嘌呤和环孢菌素联合治疗的效果以及与不良结果相关的参数。方法：纳入 51 名特发性 FSGS 患者并随访 5 年。 25 名患者单独接受泼尼松龙（1 毫克/千克体重/天）或泼尼松龙（0.5 毫克/千克体重/天）与硫唑嘌呤（2 毫克/千克体重/天）或环孢菌素（3 毫克/千克体重/天）的联合治疗，剂量逐渐减少，而 26 名患者未接受免疫抑制药物治疗。较低的泼尼松龙剂量方案被用作肥胖、边缘性糖尿病患者或骨病患者的初始治疗。使用基线血清肌酐的 50% 或加倍和/或终末期肾衰竭的终点来估计临床病程。通过单变量和多变量分析评估临床和组织学参数对临床结果的贡献。结果：在随访期间，观察到 2 名接受治疗和 9 名未接受治疗的患者的基线血清肌酐增加了 50%（8% vs. 35%，p = 0.03），而 2 名和 5 名患者的血清肌酐分别翻倍（8% vs. 19%，p = NS）。 51 名患者中有 4 名 (8%) 出现终末期肾衰竭，其中 2 名接受治疗，2 名未接受治疗 (p = NS)。与不良结果相关的参数是基线血清肌酐和肾小球硬化的严重程度（多变量分析 OR = 1.08，p = 0.01）。大多数达到终点的患者（68%）在随访期间患有持续性肾病综合征。在治疗组中观察到肾病综合征缓解的频率更高（75% vs. 30.7%，p = 0.05）。单独使用泼尼松龙后，62.5% 的患者肾病综合征得到缓解，而较低剂量的泼尼松龙与硫唑嘌呤和环孢菌素联合用药后，分别有 80% 和 85.7% 的患者肾病综合征得到缓解。没有观察到严重的副作用。结论：本研究和之前的研究表明，类固醇和/或免疫抑制治疗对于改善 FSGS 患者的临床病程和缓解肾病综合征具有一定作用。低剂量泼尼松龙与环孢素的组合可以作为常规泼尼松龙剂量副作用风险较高的患者的初始治疗。版权所有 (c) 2006 S. Karger AG，巴塞尔。
Background/Aims: Focal segmental glomerulosclerosis (FSGS) is a common type of glomerular disease that can lead to chronic renal failure. Various therapeutic regimens have been used in nephrotic FSGS patients. The effect of treatment with prednisolone alone or its combination with azathioprine and cyclosporin and parameters related to a poor outcome are studied. Methods: Fifty-one patients with idiopathic FSGS and a follow-up period of 5 years were included. Twenty-five were treated with prednisolone alone (1 mg/kg BW/day) or combination of prednisolone (0.5 mg/kg BW/day) with azathioprine (2 mg/kg BW/day) orcyclosporine (3 mg/kg BW/day) in gradually reduced doses whereas 26 patients received no immunosuppressive drugs. Lower prednisolone dose regimens were used as initial treatment in obese, borderline diabetics or patients with bone disease. The clinical course was estimated using the end-points of 50% or doubling of baseline serum creatinine and/or end-stage renal failure. The contribution of clinical and histological parameters in the clinical outcome was estimated by univariate and multivariate analyses. Results: Increase of baseline serum creatinine by 50% during the follow-up period was observed in 2 treated and 9 untreated patients (8% vs. 35%, p = 0.03) whereas doubling of serum creatinine in 2 and 5 patients respectively (8% vs. 19%, p = NS). End-stage renal failure developed in 4 of 51 patients (8%), 2 treated and 2 untreated (p = NS). Parameters related to a poor outcome were baseline serum creatinine and severity of glomerulosclerosis (multivariate analysis OR = 1.08, p = 0.01). Most of patients (68%) who reached end-points had persistent nephrotic syndrome during the follow-up. Remission of nephrotic syndrome was observed more frequently among treated (75 vs. 30.7%, p = 0.05). Prednisolone alone was followed by remission of nephrotic syndrome in 62.5% whereas combination of lower prednisolone dose with azathioprine and cyclosporin in 80 and 85.7% of patients. No serious side-effects were observed. Conclusion:This and previous studies suggest that steroid and/or immunosuppressive therapy have a role in amelioration of the clinical course and remission of nephrotic syndrome in patients with FSGS A combination of low predisolone dose with cyclosporine could be used as initial treatment in patients with higher risk for side-effects from the usual prednisolone dose. Copyright (c) 2006 S. Karger AG, Basel.