Teeninga Nynke, Schreuder Michiel F, Bökenkamp Arend, Delemarre-van de Waal Henriette A, van Wijk Joanna A E
Department of Paediatric Nephrology, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
Nephrol Dial Transplant. 2008 May;23(5):1615-20. doi: 10.1093/ndt/gfm829. Epub 2007 Dec 8.
Low birth weight (LBW) has been shown to lead to a low nephron endowment with subsequent glomerular hyperfiltration. Additional renal disease can therefore be expected to have a more severe course. Minimal change nephrotic syndrome (MCNS) is a common chronic illness in childhood. As it is important to be able to predict prognosis in MCNS, we set out to study the effect of LBW on MCNS in a cohort of patients from our University Medical Center, and performed a meta-analysis.
A retrospective chart review of children with MCNS treated at the VU University Medical Center was performed, identifying 55 patients of whom 4 had LBW. The meta-analysis was performed using Review Manager (The Cochrane Collaboration).
The meta-analysis consisted of 201 patients (25 LBW, 176 normal birth weight). More LBW patients were classified as steroid resistant [odds ratio (OR) 6.97 (95% confidence interval [CI] 2.02-24.04), P = 0.002]. The number of relapses per year of follow-up was significantly higher in the LBW patients with MCNS [weighted mean difference 0.93 (95% CI 0.71-1.15) relapse per year, P < 0.0001]. MCNS patients with LBW were significantly more likely to be treated with cyclosporine [OR 4.4 (95% CI 1.7-11.8), P = 0.003] or cytotoxic agents [OR 4.2 (95% CI 1.8-10.2), P = 0.001] during the course of their disease, and they had a higher chance of developing several complications during the follow-up period, including hypertension.
This meta-analysis provides support for an adverse effect of LBW on the course and prognosis of MCNS in children, which can aid clinicians and parents in assessing the expected clinical course.
低出生体重（LBW）已被证明会导致肾单位数量减少，进而引起肾小球高滤过。因此，可以预期额外的肾脏疾病会有更严重的病程。微小病变肾病综合征（MCNS）是儿童期常见的慢性病。由于能够预测MCNS的预后很重要，我们着手研究低出生体重对我校医学中心一组患者的MCNS的影响，并进行了一项荟萃分析。
对在VU大学医学中心接受治疗的MCNS儿童进行回顾性病历审查，确定了55例患者，其中4例为低出生体重。使用Review Manager（Cochrane协作网）进行荟萃分析。
荟萃分析包括201例患者（25例低出生体重，176例正常出生体重）。更多低出生体重患者被归类为激素抵抗型[比值比（OR）6.97（95%置信区间[CI]2.02 - 24.04），P = 0.002]。低出生体重的MCNS患者每年的复发次数显著更高[加权平均差为每年0.93次复发（95%CI 0.71 - 1.15），P < 0.0001]。低出生体重的MCNS患者在病程中接受环孢素治疗[OR 4.4（95%CI 1.7 - 11.8），P = 0.003]或细胞毒性药物治疗[OR 4.2（95%CI 1.8 - 10.2），P = 0.001]的可能性显著更高，并且在随访期间发生多种并发症（包括高血压）的几率更高。
这项荟萃分析支持低出生体重对儿童MCNS的病程和预后有不良影响，这有助于临床医生和家长评估预期的临床病程。
