MODERATELY PROTEINURIC IGA NEPHROPATHY - PROGNOSTIC PREDICTION OF INDIVIDUAL CLINICAL COURSES AND STEROID-THERAPY IN PROGRESSIVE CASES
MODERATELY PROTEINURIC IGA NEPHROPATHY - PROGNOSTIC PREDICTION OF INDIVIDUAL CLINICAL COURSES AND STEROID-THERAPY IN PROGRESSIVE CASES
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DOI：
10.1159/000185753
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发表时间：
1989-11-01
期刊：
影响因子：
2.5
通讯作者：
TATENO, S
中科院分区：
文献类型：
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作者：
KOBAYASHI, Y;HIKI, Y;TATENO, S
60例持续中度蛋白尿1.0 - 2.0 g/d的患者中有18例接受了平均18个月的类固醇治疗，长期随访超过4年。这18例患者中有15例患者的初始肌酐清除率（Ccr）维持在70 ml/min或更高。其余42人接受抗血小板药物和/或非甾体抗炎药，其中31人保持其初始Ccr值为70 ml/min或更高。激素组和非激素组中初始Ccr值均小于70 ml/min的所有14例患者均进行了进展性病程，其中12例最终接受了血液透析。非类固醇激素组31例，12例病程稳定，10例病程进展，9例终末期肾功能衰竭，需要血液透析。这三个亚组之间的初始临床特征没有差异。但稳定组的组织学改变较进展组和血液透析组轻。此外，除1例稳定亚组病例外，所有病例的8个组织学参数的总分均为6或更低，但其他两个亚组的8或更高。因此，在初始Ccr值≥ 70 ml/min且总分≥ 7的单独进展病例中，比较了类固醇和非类固醇组（分别为10例和20例）的长期临床病程。与非激素组相比，激素组尿蛋白明显减少，肾功能保留良好。两组治疗后第1年蛋白尿程度（p < 0.05）和治疗后第3年Ccr值（p < 0.05）比较差异有显著性。这些结果表明，适当的类固醇治疗是有益的，即使在进行性病例中度蛋白尿和中度至重度组织学改变，如果只有初始肾功能与Ccr值70 ml/min或更高的保留。
Eighteen of 60 patients with persistent moderate proteinuria between 1.0 and 2.0 g/day and a long-term follow-up of more than 4 years received steroid therapy for a mean period of 18 months. Fifteen of these 18 patients maintained their initial creatinine clearance (Ccr) of 70 ml/min or more. The remaining 42 received antithrombocyte drugs and/or nonsteroidal anti-inflammatory drugs, with 31 of them keeping their initial Ccr values of 70 ml/min or more. All 14 cases with initial Ccr values of less than 70 ml/min in both the steroid and nonsteroid groups followed progressive courses, with 12 ending up in hemodialysis. Of the nonsteroid, preserved group of 31 cases, 12 followed a stable course, 10 a progressive course, and the other 9 went into end-stage renal failure necessitating hemodialysis. There were no differences in initial clinical features among these three subgroups. But histological changes were milder in the stable subgroup than in the progressive and hemodialysis subgroups. Further, the total score of eight histological parameters was 6 or less in all but 1 of the cases of the stable subgroup, but 8 or higher in the other two subgroups. Therefore, in the progressive cases alone with initial Ccr values of 70 ml/min or more and high total scores of 7 or more, the long-term clinical courses were compared between steroid and nonsteroid groups (10 and 20 cases, respectively). In the steroid group proteinuria decreased significantly and renal function was preserved well as compared with that in the nonsteroid group. There were significant differences in the degrees of proteinuria in the 1st year (p < 0.05) and in the Ccr values 3 years after initiation of therapy (p < 0.05) between the two groups. These results indicate that appropriate steroid therapy is beneficial even in progressive cases with moderate proteinuria and moderate to severe histological alterations, if only initial renal function with Ccr values of 70 ml/min or more is preserved.