Tarshish P, Bernstein J, Tobin J N, Edelmann C M
Albert Einstein College of Medicine, Bronx, New York.
Pediatr Nephrol. 1992 Mar;6(2):123-30. doi: 10.1007/BF00866289.
It has been claimed that long-term prednisone treatment ameliorates the course of children with mesangiocapillary glomerulonephritis (MCGN). The International Study of Kidney Disease in Children conducted a randomized, double-blinded, placebo-controlled clinical trial in 80 children with idiopathic MCGN, including 42 patients with type I disease, 14 with type II disease, 17 with type III disease, and 7 with nontypable disease. Criteria for admission included heavy proteinuria and a glomerular filtration rate of greater than or equal to 70 ml/min per 1.73 m2. Prednisone or lactose, 40 mg/m2, was given every other day as a single morning dose. The mean duration of treatment was 41 months, renal failure being the most common reason for termination of therapy. Treatment failure was defined as an increase from baseline of 30% or more in serum creatinine, or more than 35 mumol/l. Overall, treatment failure occurred in 55% of patients treated with lactose, compared with 40% in the prednisone group. Life-table analysis showed a renal survival rate (i.e., stable renal function) at 130 months of 61% among patients receiving prednisone and 12% among patients receiving lactose (P = 0.07). Of patients with type I or III MCGN, 33% treated with prednisone were treatment failures, compared with 58% in the lactose group. Long-term treatment with prednisone appears to improve the outcome of children with MCGN.
有人声称长期使用泼尼松治疗可改善系膜毛细血管性肾小球肾炎（MCGN）患儿的病程。儿童肾病国际研究对80例特发性MCGN患儿进行了一项随机、双盲、安慰剂对照临床试验，其中包括42例I型疾病患儿、14例II型疾病患儿、17例III型疾病患儿和7例无法分型疾病患儿。入选标准包括大量蛋白尿和肾小球滤过率大于或等于70 ml/min每1.73 m²。泼尼松或乳糖，40 mg/m²，每隔一天作为单次晨起剂量给药。平均治疗持续时间为41个月，肾衰竭是治疗终止的最常见原因。治疗失败定义为血清肌酐较基线水平升高30%或更多，或超过35 μmol/l。总体而言，接受乳糖治疗患者的治疗失败率为55%，而泼尼松组为40%。寿命表分析显示，接受泼尼松治疗的患者在130个月时的肾脏存活率（即稳定的肾功能）为61%，接受乳糖治疗的患者为12%（P = 0.07）。在I型或III型MCGN患儿中，接受泼尼松治疗的患者有33%治疗失败，而乳糖组为58%。长期使用泼尼松治疗似乎可改善MCGN患儿的预后。
