RACIAL-DIFFERENCES IN THE INCIDENCE AND RENAL OUTCOME OF IDIOPATHIC FOCAL SEGMENTAL GLOMERULOSCLEROSIS IN CHILDREN
RACIAL-DIFFERENCES IN THE INCIDENCE AND RENAL OUTCOME OF IDIOPATHIC FOCAL SEGMENTAL GLOMERULOSCLEROSIS IN CHILDREN
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DOI：
10.1007/bf01453661
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发表时间：
1991-01-01
影响因子：
3
通讯作者：
TEJANI, A
中科院分区：
文献类型：
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作者：
INGULLI, E;TEJANI, A
北美儿科登记处报告称，从 1987 年到 1989 年，黑人和西班牙裔儿童占所有肾移植手术的 23%，但其中 38% 是因局灶节段性肾小球硬化症 (FSGS) 进行的肾移植手术。 根据这些数据，我们推断，与白人儿童相比，黑人和西班牙裔进展为终末期肾病 (ESRD) 的 FSGS 患者数量不成比例。 为了探索这一假设，我们评估了 FSGS 的单中心经验，将黑人和西班牙裔儿童与白人儿童进行比较。 1974 年至 1989 年间，我们诊所对 177 名黑人和西班牙裔儿童进行了特发性肾病综合征 (NS) 随访，其中 57 名被诊断为 FSGS（I 组）。 这些 I 组患者的 NS 发病平均年龄为 7.3 +/- 4.6 岁，平均随访时间为 8.25 +/- 4.3 年。 同一时期，65 名患有特发性 NS 的白人患者（第 II 组）中，有 13 名被发现患有 FSGS。 他们的平均年龄（7.8 +/- 4.8 岁）和随访时间（8.8 +/- 4.8 年）相似。 两组的治疗方式也相似。 在 I 组患者中，78% (42/54) 达到 ESRD，而 II 组患者中这一比例为 33% (4/12) (P < 0.01)。 生命表分析显示，50% 的黑人和西班牙裔儿童将在 FSGS 后 3 年内达到 ESRD。 在一组患者中，多元回归分析显示，NS 发病时血清肌酐越高（P < 0.01，r = 0.519），NS 发病时血清胆固醇越高（P < 0.02，r = 0.511），进展为 ESRD 的速度越快。 根据我们的研究结果，有必要进行一项全国性调查，以确定 FSGS 对黑人和西班牙裔儿童是否更具毒性。
The North American Pediatric Registry reports that from 1987 to 1989 blacks and Hispanic children accounted for 23% of all renal transplants performed but 38% of those performed for focal segmental glomerulosclerosis (FSGS). From these data, we infer that blacks and Hispanics form a disproportionate number of FSGS patients who progress to end-stage renal disease (ESRD) compared with white children. To explore this hypothesis we assessed our single-center experience of FSGS comparing black and Hispanic with white children. Of 177 black and Hispanic children followed in our clinic for idiopathic nephrotic syndrome (NS) between 1974 and 1989, 57 were diagnosed as having FSGS (group I). The mean age at onset of NS of these group I patients was 7.3 +/- 4.6 years and the mean duration of follow-up was 8.25 +/- 4.3 years. During the same period, 13 of 65 white patients (group II) with idiopathic NS were found to have FSGS. Their mean age (7.8 +/- 4.8 years) and duration of follow-up (8.8 +/- 4.8 years) were similar. Therapeutic modalities in the two groups were also similar. Of group I patients, 78% (42/54) reached ESRD compared with 33% (4/12) of group II patients (P < 0.01). Life table analysis showed that 50% of black and Hispanic children will reach ESRD within 3 years of FSGS. In a subset of patients, multiple regression analysis revealed that the higher the serum creatinine at the onset of NS (P < 0.01, r = 0.519), and the higher the serum cholesterol at the onset of NS (P < 0.02, r = 0.511), the more rapid the progression to ESRD. Based on our findings, a national survey to determine if FSGS is more virulent in black and Hispanic children is warranted.