Steroid therapy during the early stage of progressive IgA nephropathy - A 10-year follow-up study
Steroid therapy during the early stage of progressive IgA nephropathy - A 10-year follow-up study
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DOI：
10.1159/000188848
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发表时间：
1996-02-01
期刊：
影响因子：
2.5
通讯作者：
Tateno, S
中科院分区：
文献类型：
--
作者：
Kobayashi, Y;Hiki, Y;Tateno, S
本研究旨在阐明皮质类固醇对早期进展性伊加肾病长期临床病程的影响。进行性伊加肾病的早期阶段被定义为具有1和2g/天之间的中度蛋白尿，肌酐清除率值为70 ml/min或更高，并且组织学严重程度评分为7或更高。自1972年起的12年间，满足这三个条件并在我们的肾脏科连续随访10年或更长时间的患者数量为46例。其中20人接受了平均18个月的类固醇治疗，其余26名患者没有接受类固醇治疗。两组之间的蛋白尿、肌酐清除率值、高血压病例频率和7分或以上的组织学评分的初始数据无差异：分别为1.4 +/- 0.4 vs. 1.3 +/- 0.3 g/天、85 +/- 14 vs. 88 +/- 13 ml/min、25 vs. 38%和10.7 +/- 2.5 vs. 11.0 +/- 3.0。在10年的随访期间，两组之间的肾脏存活率存在显著差异（开始治疗后5年为100 vs. 84%，10年后为80 vs. 34%; p < 0.001）。两组之间的最终肌酐清除率值有显著差异（54 +/- 35 vs. 20 +/- 29 ml/min; p < 0.005）。另一方面，轻度组织学改变或因中度蛋白尿导致肾功能下降的患者组在最终结局方面没有显着差异。这些结果表明，糖皮质激素是有益的，在长期稳定肾功能的早期阶段进行性伊加肾病，虽然本研究不是一个随机的。
This study was undertaken to clarify the effect of corticosteroids on the longterm clinical course of the early stage of progressive IgA nephropathy. The early stage of progressive IgA nephropathy was defined as having moderate proteinuria between 1 and 2 g/day, creatinine clearance values of 70 ml/min or more, and a histological severity score of 7 or more. The number of patients who fulfilled these three conditions during 12 years from 1972 and then were continuously followed up for 10 years or more in our renal unit was 46. Twenty of them received steroid treatment for an average period of 18 months, and the remaining 26 patients had no steroid treatment. The initial data of proteinuria, creatinine clearance values, frequency of hypertensive cases, and histological scores of 7 or more were not different between the two groups: 1.4 +/- 0.4 vs. 1.3 +/- 0.3 g/day, 85 +/- 14 vs. 88 +/- 13 ml/min, 25 vs. 38%, and 10.7 +/- 2.5 vs. 11.0 +/- 3.0, respectively. During the follow-up period of 10 years, the renal survival rate was significantly different between the two groups (100 vs. 84% 5 years after starting therapy and 80 vs. 34% 10 years later; p < 0.001). The final creatinine clearance values were significantly different between the two groups (54 +/- 35 vs. 20 +/- 29 ml/min; p < 0.005). On the other hand, the patient groups with mild histological changes or decreased renal function due to moderate proteinuria showed no significant differences in the final outcome. These results indicate that corticosteroids are beneficial in stabilizing the renal function for a long time during the early stage of progressive IgA nephropathy, although this study was not a randomized one.