Plank Christian, Ostreicher Iris, Dittrich Katalin, Waldherr Rüdiger, Voigt Manfred, Amann Kerstin, Rascher Wolfgang, Dötsch Jörg
Department of Paediatrics, Kinder- and Jugendklinik, University of Erlangen-Nuremberg, Loschgestrasse 15, 91056 Erlangen, Germany.
Pediatr Nephrol. 2007 Nov;22(11):1881-9. doi: 10.1007/s00467-007-0597-9. Epub 2007 Sep 14.
Clinical and animal studies have shown a higher risk of an aggravated course of renal disease in childhood after birth for babies small for gestational age (SGA). In addition relative "supernutrition" and fast weight gain in early infancy seem to support the development of later disease. In a retrospective analysis of 62 cases of idiopathic nephrotic syndrome treated between 1994 and 2004 at a university centre for paediatric nephrology, we related the course of disease to birth weight and to the weight gain in the first 2 years of life. Six children were born SGA (birth weight <-1.5 standard deviation score), and 56 were born as appropriate for gestational age (AGA). In all SGA children renal biopsy was performed, while only 55% of the AGA children underwent renal biopsy (P = 0.07), showing no difference in renal histology. In the SGA group, four of six patients developed steroid resistance (vs 12/56 AGA, P < 0.05). Of the SGA children, 83% needed antihypertensive treatment in the course of the disease compared to 39% of the AGA children (P = 0.07). The extent of weight gain between birth and 24 months of age did not influence the course of disease. In conclusion, we were able to find evidence for an aggravated course of idiopathic nephrotic syndrome in former SGA children. Independently of birth weight, weight gain in the first 2 years of life did not influence the course of disease.
临床和动物研究表明，小于胎龄儿（SGA）出生后在儿童期患肾病病情加重的风险更高。此外，婴儿早期相对的“营养过剩”和快速体重增加似乎会促使后期疾病的发展。在一所大学儿科肾脏病中心对1994年至2004年期间治疗的62例特发性肾病综合征病例进行的回顾性分析中，我们将疾病进程与出生体重以及生命最初2年的体重增加情况联系起来。6名儿童为小于胎龄儿（出生体重<-1.5标准差评分），56名儿童为适于胎龄儿（AGA）。所有小于胎龄儿均进行了肾活检，而只有55%的适于胎龄儿接受了肾活检（P = 0.07），肾组织学检查无差异。在小于胎龄儿组中，6名患者中有4名出现激素抵抗（适于胎龄儿组为12/56，P < 0.05）。在小于胎龄儿中，83%在疾病过程中需要降压治疗，而适于胎龄儿为39%（P = 0.07）。出生至24个月龄之间的体重增加幅度并未影响疾病进程。总之，我们能够找到证据表明前小于胎龄儿患特发性肾病综合征的病情会加重。与出生体重无关，生命最初2年的体重增加并未影响疾病进程。
