Pokhariyal Saurabh, Gulati Sanjeev, Prasad Narayan, Sharma Raj Kumar, Singh Uttam, Gupta Ramesh Kumar, Mittal Sanjay, Mehta Bhavna
Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
J Nephrol. 2003 Sep-Oct;16(5):691-6.
We conducted a retrospective study to evaluate the duration of optimal steroid therapy in idiopathic focal segmental glomerulosclerosis (FSGS). We evaluated 93 adult patients (n=65 males) with biopsy proven FSGS. Mean proteinuria was 5.4 +/- 2.8 gm/dL. Twelve patients were lost at follow-up. Of the remaining 81 patients, nephrotic range proteinuria was present in 48 (59%), and 21 (26%) presented with renal insufficiency. Of these patients, three (3.9%) experienced spontaneous remission. Seven patients were managed symptomatically with ACE inhibitors and never received steroids. Of the 71 patients, 32 received >16 weeks of steroid therapy, while 39 received <16 weeks of steroid therapy. Twenty-four patients (75%) who received >16 weeks of steroid therapy had a complete or partial remission, while only 18 (46%) of those with <16 weeks of steroid therapy had a steroid response (p=0.001). Patients with more than 25% interstitial fibrosis at biopsy also showed significantly lower remission rates (p=0.02). Hypertension, hematuria and degree of proteinuria did not significantly affect the response to steroid therapy. Univariate logistic regression analysis showed that the factors predictive of remission were: (1) steroid therapy duration (p=0.001); (2) serum creatinine (Cr) at onset (p=0.001) and; (3) presence of interstitial fibrosis (>25%) at initial biopsy (p=0.02). Multivariate logistic regression analysis showed that the only factor predictive of remission was steroid therapy duration >16 weeks (p=0.001). Therefore, we concluded that patients with idiopathic FSGS required treatment for at least 16 weeks, before labeling them as steroid non-responsive. Patients with interstitial fibrosis have a significantly poor response to therapy.
我们进行了一项回顾性研究，以评估特发性局灶节段性肾小球硬化（FSGS）的最佳类固醇治疗持续时间。我们评估了93例经活检证实为FSGS的成年患者（n = 65例男性）。平均蛋白尿为5.4±2.8克/分升。12例患者在随访中失访。在其余81例患者中，48例（59%）存在肾病范围蛋白尿，21例（26%）出现肾功能不全。在这些患者中，3例（3.9%）出现自发缓解。7例患者采用ACE抑制剂进行对症治疗，从未接受过类固醇治疗。在71例患者中，32例接受了超过16周的类固醇治疗，而39例接受了少于16周的类固醇治疗。接受超过16周类固醇治疗的24例患者（75%）完全或部分缓解，而接受少于16周类固醇治疗的患者中只有18例（46%）有类固醇反应（p = 0.001）。活检时间质纤维化超过25%的患者缓解率也显著较低（p = 0.02）。高血压、血尿和蛋白尿程度对类固醇治疗反应无显著影响。单因素逻辑回归分析显示，预测缓解的因素为：（1）类固醇治疗持续时间（p = 0.001）；（2）发病时的血清肌酐（Cr）（p = 0.001）；以及（3）初始活检时存在间质纤维化（>25%）（p = 0.02）。多因素逻辑回归分析显示，预测缓解的唯一因素是类固醇治疗持续时间>16周（p = 0.001）。因此，我们得出结论，特发性FSGS患者在被标记为类固醇无反应之前需要至少治疗16周。间质纤维化患者对治疗反应明显较差。
