Iitaka Kikuo, Motoyama Osamu, Nakamura Shinya, Koshino Hiroe, Sakai Tadasu
Department of Pediatrics, International University of Health and Welfare, Atami Hospital, 13-1 Higashikaigan-cho, Atami, Shizuoka 413-0012, Japan.
Clin Exp Nephrol. 2008 Feb;12(1):28-32. doi: 10.1007/s10157-007-0014-5. Epub 2008 Jan 5.
Many chronic renal diseases in children, including membranoproliferative glomerulonephritis (MPGN), often continue into adulthood, and these patients require continuing management. Despite the importance of the topic, there has been limited discussion about the problems of transition in children with continuing renal disease. We report our experience in patients with MPGN, as they matured from childhood to adolescence and adulthood, so-called "carry-over" cases.
The clinical course of diffuse MPGN in 27 children was retrospectively reviewed. Patients were over 18 years old at the end of follow-up.
The mean follow-up period was 12.6 years; 20 children (74%) were identified by school urinary screening. The clinical course was favorable, and none of the patients progressed to end-stage renal failure during follow-up. However, eight patients (30%) continued to demonstrate proteinuria; two patients were nephrotic. Four patients were non-compliant and discontinued medication by themselves. Three patients were still on low dose of alternate-day (ALD) prednisolone. Twenty patients finished the treatment and were followed for an average of 4.6 years. Only one demonstrated trace amounts of proteinuria 1 year after discontinuing ALD prednisolone.
MPGN often continues during maturation from childhood to adulthood, and patients are usually referred to adult nephrologists. Good communication between pediatric and adult nephrologists is important. In addition, more in depth explanation and reeducation about their disease and its management are helpful when these patients reach adolescence. These measures will improve their care and help to assure compliance with their medication regimen.
许多儿童慢性肾脏病，包括膜增生性肾小球肾炎（MPGN），常常会延续至成年期，这些患者需要持续的管理。尽管该话题很重要，但对于患有持续性肾脏病儿童的转诊问题，讨论却很有限。我们报告了我们对MPGN患者从儿童期到青春期及成年期（即所谓的“延续”病例）的治疗经验。
对27例儿童弥漫性MPGN的临床病程进行了回顾性分析。随访结束时患者年龄均超过18岁。
平均随访期为12.6年；20例儿童（74%）通过学校尿液筛查确诊。临床病程良好，随访期间无患者进展至终末期肾衰竭。然而，8例患者（30%）持续存在蛋白尿；2例为肾病综合征。4例患者不依从并自行停药。3例患者仍在接受小剂量隔日泼尼松龙治疗。20例患者完成治疗，平均随访4.6年。仅1例在停用隔日泼尼松龙1年后出现微量蛋白尿。
MPGN常从儿童期延续至成年期，患者通常需转诊至成人肾脏病专家处。儿科和成人肾脏病专家之间的良好沟通很重要。此外，当这些患者进入青春期时，对其疾病及其治疗进行更深入的解释和再教育会有所帮助。这些措施将改善他们的治疗并有助于确保其坚持药物治疗方案。
