Long-term follow up of pediatric immunoglobulin A nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy
Long-term follow up of pediatric immunoglobulin A nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy
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DOI：
10.1111/ped.13074
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发表时间：
2017-01-01
影响因子：
1.4
通讯作者：
Hosoya，Mitsuaki
中科院分区：
文献类型：
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作者：
Kawasaki，Yukihiko;Maeda，Ryo;Hosoya，Mitsuaki
本研究的目的是阐明扁桃体切除术加甲基强的松龙脉冲治疗（扁桃体切除术脉冲治疗[TMP]）治疗儿童免疫球蛋白A肾病（IgAN）的长期疗效。在长期随访中评估了临床和实验室结果以及TMP治疗IgAN的预后。方法收集33例接受TMP治疗的IgAN患儿的资料。这些儿童被回顾性地分为两组。第1组18例患儿采用TMP作为初始治疗，第2组15例患儿采用TMP作为IgAN复发的抢救治疗。分析两组患者的临床特点、实验室及病理表现，包括第一次、第二次肾活检及最新随访。结果1、2组患者平均尿蛋白排泄量、血尿发生率、血清肌酐均较术前显著降低。1、2组患者术后肾小球呈新月形的百分率明显低于治疗前。在最近的随访中，94%的1组患者和87%的2组患者尿正常，6%的1组和13%的2组患者有轻微的尿异常，两组患者均无活动性肾脏疾病或肾功能不全。结论stmp作为初始治疗和抢救治疗均能有效改善儿童IgAN的泌尿系统异常和长期预后。
BackgroundThe aim of this study was to clarify the long‐term efficacy of tonsillectomy plus methylprednisolone pulse therapy (tonsillectomy pulse therapy [TMP]) for pediatric immunoglobulin A nephropathy (IgAN). The clinical and laboratory findings as well as the prognosis for IgAN treated with TMP at long‐term follow up were evaluated.MethodsWe collected data on 33 IgAN children treated with TMP. The children were retrospectively divided into two groups. Group 1 consisted of 18 children treated with TMP as the initial therapy, and group 2 consisted of 15 children treated with TMP as rescue therapy for IgAN relapse. The clinical features, and laboratory and pathological findings, including those at first and second renal biopsy as well as at the latest follow up, were analyzed for both groups.ResultsMean urinary protein excretion, incidence of hematuria, and serum creatinine in groups 1 and 2 were all decreased significantly after TMP compared with beforehand. The percentage of glomeruli showing crescents after TMP in groups 1 and 2 was significantly lower than before TMP. At the most recent follow up, 94% of patients in group 1 and 87% in group 2 had normal urine, 6% in group 1 and 13% in group 2 had minor urinary abnormalities, and no patients in either group had active renal disease or renal insufficiency.ConclusionsTMP is effective in ameliorating urinary abnormalities and improving the long‐term outcome of pediatric IgAN both as an initial and as a rescue treatment.