Effectiveness of the steroid therapy on the histological parameters of IgA nephropathy in children

本研究的目的是阐明类固醇治疗（ST;泼尼松龙1 mg/kg/d）对儿童伊加肾病（IgAN）组织学参数的有效性。分析了100例患者（Pts）（11.7 ± 2.6岁），他们在第一次肾活检（RBx）时被诊断为IgAN，并在第一次RBx后2年以上接受了第二次RBx。根据ST（+）或无ST（-）、尿常规消失（-）或持续（+）分为4组（UM;血尿和/或蛋白尿），因此包括A组，31例患者ST+，UM-组16例，B组16例，ST-，UM-组25例，ST-，UM+组28例。在每组中，计算具有由系膜增生（Gm）、毛细血管内病变（Gi）、毛细血管外病变（Ge）、整体硬化（Gs）和间质病变（i）组成的每个活动性（A）或慢性（C）病变的肾小球数量的百分比，并在第1和第2 RBx之间进行统计学比较。A组AGm、AGi、AGe及CGe改善，CGs、Ci进展。D组Ai、CGs、CGi、CGe、Ci均明显升高。在A组和B组之间，ST前B组CG的百分比显著高于A组，而ST后B组AGi、AGe和CGe的百分比显著高于A组。总之，ST可有效改善活动性毛细血管内和毛细血管外病变以及慢性毛细血管外病变，并可有效对抗其他慢性病变的进展。然而，有限的患者即使在ST后仍显示活动性毛细血管内以及活动性和慢性毛细血管外病变，仍有待进一步分析其过程。

The purpose of this study is to clarify the effectiveness of the steroid therapy (ST; predonisolone 1mg/kg/day) on the histological parameters of IgA nephropathy (IgAN) in children. The 100 patients (Pts) (11.7+-2.6 y/o), who were diagnosed as IgAN by the 1st renal biopsy (RBx) and underwent the 2nd RBx more than 2 years after the 1st RBx, were analyzed. Pts were divided into 4 groups according to either with (+) or without (-) ST, and either with disappearance (-) or continuance (+) of urine manifestation (UM; hematuria and/or proteinuria) at the time of 2nd RBX, which consequently consisted of group A, 3lPts (ST+, UM-), group B, 16Pts (ST+, UM+), group C, 25Pts (ST-, UM-), and group D, 28Pts, (ST-, UM+). In each group, a percentage of the number of glomeruli with each active (A) or chronic (C) lesions consisting of mesangial proliferation (Gm), intracapillary lesion (Gi), extracapillary lesion (Ge), global sclerosis (Gs), and interstitial lesion (i) were calculated and were compared statistically between 1st and 2nd RBx. In group A, AGm, AGi, AGe as well as CGe showed improvement, whereas CGs and Ci showed progression. In group D, progression of Ai, CGs, CGi, CGe, and Ci was shown. Between group A and B, the percentage of CGs was significantly higher in group B than those of group A before ST, whereas the percentage of AGi, AGe, and CGe was significantly higher in group B than those of group A after ST. In conclusion, ST was effective for improvement of active intracapillary and extracapillary lesions as well as chronic extracapillary lesions and was effective against progression of the other chronic lesions. However, the limited Pts showed still active intracapillary as well as active and chronic extracapillary lesions even after ST, remains to be further analyzed on their process.