Sheu J N, Chen J H
Department of Pediatrics, Division of Pediatric Nephrology, Chung Shan Medical and Dental College Hospital, Taichung, Taiwan, Republic of China.
Am J Kidney Dis. 2001 May;37(5):909-14. doi: 10.1016/s0272-6386(05)80005-8.
It has been well established that intrauterine growth retardation (IUGR) is associated with greater morbidity and mortality rates during perinatal and adult life. The aim of this study is to clarify whether IUGR, defined as a birth weight less than the 10th percentile for gestational age, influences the clinical course of minimal change nephrotic syndrome (MCNS) in children. The study included 50 children aged 1 to 13 years at the onset of MCNS. The diagnosis of MCNS was confirmed by renal biopsy in 25 children (50%). Eight children (16%) had IUGR at birth. Comparisons between children with and without IUGR showed significant differences in mean number of relapses (13.0 +/- 3.5 versus 3.4 +/- 3.0 relapses; P < 0.0001) and relapse rates (relapses per year, 1.6 +/- 0.3 versus 0.5 +/- 0.4; P < 0.0001). We also observed a greater incidence of steroid dependence (100% versus 21.4%; P < 0.001) in children with than without IUGR. In addition, children with IUGR underwent treatment with cytotoxic agents and cyclosporine more frequently than those without IUGR. There was a significantly greater incidence of complications and concomitant diseases of nephrotic syndrome in children with IUGR; results show that MCNS in children with IUGR had a more unfavorable course and outcome. It is important for clinicians to be aware that IUGR may help in the early identification of children at greater risk for frequent relapses and the development of steroid dependence and/or steroid resistance. More aggressive therapy may be indicated for these children.
宫内生长受限（IUGR）与围产期及成年期更高的发病率和死亡率相关，这一点已得到充分证实。本研究的目的是阐明，定义为出生体重低于胎龄第10百分位数的IUGR是否会影响儿童微小病变肾病综合征（MCNS）的临床病程。该研究纳入了50例MCNS发病时年龄在1至13岁的儿童。25例儿童（50%）通过肾活检确诊为MCNS。8例儿童（16%）出生时患有IUGR。有IUGR和无IUGR儿童之间的比较显示，平均复发次数（13.0±3.5次复发与3.4±3.0次复发；P<0.0001）和复发率（每年复发次数，1.6±0.3与0.5±0.4；P<0.0001）存在显著差异。我们还观察到，有IUGR的儿童比无IUGR的儿童类固醇依赖发生率更高（100%对21.4%；P<0.001）。此外，有IUGR的儿童比无IUGR的儿童更频繁地接受细胞毒性药物和环孢素治疗。有IUGR的儿童肾病综合征并发症和伴随疾病的发生率显著更高；结果表明，有IUGR的儿童MCNS病程和结局更不利。临床医生必须意识到，IUGR可能有助于早期识别频繁复发、发生类固醇依赖和/或类固醇抵抗风险更高的儿童。对于这些儿童可能需要更积极的治疗。
