Treatment and Prognosis of Primary Focal Segmental Glomerulosclerosis
Treatment and Prognosis of Primary Focal Segmental Glomerulosclerosis
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原发性局灶节段性肾小球硬化症的治疗和预后
DOI：
10.1159/000348468
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发表时间：
2013-01-01
期刊：
影响因子：
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通讯作者：
Chen, Nan
中科院分区：
文献类型：
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作者：
Ren, Hong;Shen, Pingyan;Chen, Nan
本研究旨在分析原发性局灶节段性肾小球硬化（FSGS）患者的治疗、临床结局和影响预后的危险因素，并为此类患者的各种治疗方案提供理论依据。本研究回顾了2002年1月至2011年10月在瑞金医院治疗的168例原发性FSGS患者的临床、实验室和病理资料。其中男性108例（64.3%），女性60例（35.7%）。发病的中位年龄为38岁（范围12-78岁）。中位病史为10个月（范围4天至30年）。平均蛋白尿水平为2.3 ± 0.6 g/天。肾病综合征75例（44.6%）。平均血清肌酸酐为108.1 +/- 8.9 μ mol/l。在25.3 ± 11.4个月的随访期内，4例患者发生终末期肾功能衰竭，4例均存活。在血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂治疗组中，以下因素被确定为血清肌酐较基线升高50%的风险因素：随访期间基线eGFR <1 g/d，肾小球硬化> 1级，肾小管间质病变> 1期。在激素治疗组中，达到稳定缓解的患者比激素依赖患者有更好的肾功能保留和更轻的肾小球硬化（p < 0.01）。与激素依赖型患者相比，激素抵抗型FSGS患者肾小球硬化的组织学严重程度更差（p
This study aimed to analyze the treatment, clinical outcomes, and risk factors that affect the prognosis of patients with primary focal segmental glomerulosclerosis (FSGS) and to provide theoretical evidence for various treatment options in these patients. The study reviewed the clinical, laboratory, and pathological data of 168 patients with primary FSGS treated at Ruijin Hospital between January 2002 and October 2011. Of these patients, 108 were male (64.3%) and 60 were female (35.7%). The median age of disease onset was 38 years (range 12-78 years). The median case history was 10 months (range 4 days to 30 years). The mean proteinuria level was 2.3 +/- 0.6 g/day. 75 (44.6%) patients had nephrotic syndrome. The mean serum creatinine was 108.1 +/- 8.9 mu mol/l. Over a follow-up period of 25.3 +/- 11.4 months, end-stage renal failure occurred in 4 patients, and all 4 survived. In the group treated with angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, the following factors were identified as risk factors for experiencing a 50% increase in serum creatinine over the baseline: a baseline eGFR 1 g/day during the follow-up period, glomerular sclerosis >grade 1, and tubulointerstitial lesions >stage 1. In the group treated with steroids, patients who achieved a stable remission had better preserved renal function and milder glomerular sclerosis than steroid-dependent patients (p < 0.01). Steroid-resistant FSGS patients had a worse histological severity of glomerular sclerosis than steroid-dependent patients (p