Resić Halima
Centar za hemodijalizu, KCU Sarajevo.
Med Arh. 2002;56(2):85-8.
Glomerular diseases are hybrid group, mostly immunologically related kidney diseases where pathologic changes start in glomerules, but afterwards within their further process they grasp the other kidney structures. The most common clinical manifestation of the primary glomerulonephritis in the adults is nephrotic syndrome. Therefore, this elaboration aims are to estimate the therapy effect onto the different pathohistologic forms of the primary nephrotic syndrome.
Study has been conducted on 41 patients having the primary nephrotic syndrome, prior having normal kidney function. Different pathohistological forms of NS were verified by percutaneous kidney biopsy. Depending on the pathohistological finding the different therapeutic protocoles were applied. Each of the monitored patients were treated by giving steroids at least six weeks dosing them 2 mg/kg/bw/48 h, but not higher then 130 mg/48 h. In the cases of the patients having the given therapy, it did not lead them to the nephrotic syndrome remission, cyclophosphamid was induced in the dosage of 1.5-2.0 mg/kg/bw/48 h. According to the therapy reaction the patients were divided in three groups: the patients with the complete remission, with partial remission and the patients resistant to the treatment.
41 patients have been observed, 28 male and 13 female, aged between 16-69, average 32.3 years old. All patients had normal kidney function, and diseases duration from the moment of the pathohistomorphologic diagnosis had been lasting 0-2 years, from average 6.4 months. According to pathohistological diagnosis the patients were divided into four groups: a) "minimal changes" MCNS (n -11), b) focal--segmental glomerulosclerosis FSGS (n - 10) c) membraneous glomerulonephritis MGN (n-9) d) membranoproliferative MPGN (n-10). The best therapy effect had been resulted within the group with MCNS having 82% cases with the complete remission, while the group with MCNS had reacted the most adversely, 45% were resistant onto the therapy. 18 patients of the total 41 had the complete remission, 14 partial remission, and 9 of them were without remission.
The patient having the minimal changes had the best response onto the steroids therapy, while the patients having the expressive proliferative changes did not respond with the complete remission.
肾小球疾病是一组混合性疾病，大多是与免疫相关的肾脏疾病，其病理变化始于肾小球，但在疾病进一步发展过程中会累及肾脏的其他结构。成人原发性肾小球肾炎最常见的临床表现是肾病综合征。因此，本阐述旨在评估针对原发性肾病综合征不同病理组织学形式的治疗效果。
对41例原发性肾病综合征患者进行研究，这些患者之前肾功能正常。通过经皮肾活检确定肾病综合征的不同病理组织学形式。根据病理组织学检查结果应用不同的治疗方案。对每位监测患者给予至少六周的类固醇治疗，剂量为2mg/kg/体重/48小时，但不超过130mg/48小时。对于接受上述治疗但未达到肾病综合征缓解的患者，给予环磷酰胺，剂量为1.5 - 2.0mg/kg/体重/48小时。根据治疗反应将患者分为三组：完全缓解组、部分缓解组和治疗抵抗组。
观察了41例患者，其中男性28例，女性13例，年龄在16 - 69岁之间，平均32.3岁。所有患者肾功能正常，从病理组织形态学诊断时刻起疾病持续时间为0 - 2年，平均6.4个月。根据病理组织学诊断，患者分为四组：a）“微小病变”型微小病变肾病综合征（MCNS，n = 11），b）局灶节段性肾小球硬化症（FSGS，n = 10），c）膜性肾小球肾炎（MGN，n = 9），d）膜增生性肾小球肾炎（MPGN，n = 10）。MCNS组治疗效果最佳，完全缓解率达82%，而MPGN组反应最差，45%的患者对治疗抵抗。41例患者中，18例完全缓解，14例部分缓解，9例未缓解。
微小病变患者对类固醇治疗反应最佳，而有明显增殖性改变的患者不能完全缓解。
