Berg U B
Department of Paediatrics, Karolinska Institute, Huddinge University Hospital, Sweden.
Arch Dis Child. 1991 May;66(5):588-92. doi: 10.1136/adc.66.5.588.
Fifty one children with IgA nephropathy verified at biopsy have been followed up clinically and functionally for 0.4-16.8 years from the onset of symptoms. Renal function was evaluated by determining the glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) from the clearances of inulin and para-aminohippuric acid. Fifteen (29%) of the children had raised serum creatinine concentrations at the onset. Mean GFR was significantly lower than that of controls at the first investigation. During the follow up GFR and ERPF decreased and were significantly lower than in the controls after eight years of disease. The significant fall in renal function was found in children with proteinuria and especially in boys, in whom GFR and ERPF decreased from a mean (SEM) of 117 (5) and 616 (31) at 2.8 years to 97 (6) and 509 (36) ml/min/1.73 m2 at 7.5 years. Patients with raised serum creatinine concentrations at the onset had significantly lower GFRs, and patients with macroscopic haematuria at this time did not show decreased renal function at follow up. In conclusion, children with IgA nephropathy do not seem to have a benign clinical course. Boys with proteinuria show a significant decrease in renal function during follow up.
51例经活检证实为IgA肾病的患儿自症状出现后接受了0.4至16.8年的临床和功能随访。通过菊粉清除率和对氨基马尿酸清除率测定肾小球滤过率（GFR）和有效肾血浆流量（ERPF）来评估肾功能。15名（29%）患儿在发病时血清肌酐浓度升高。首次检查时平均GFR显著低于对照组。随访期间，GFR和ERPF下降，病程8年后显著低于对照组。肾功能的显著下降见于蛋白尿患儿，尤其是男孩，其GFR和ERPF从2.8岁时的平均（标准误）117（5）和616（31）降至7.5岁时的97（6）和509（36）ml/min/1.73 m²。发病时血清肌酐浓度升高的患者GFR显著较低，此时有肉眼血尿的患者在随访中肾功能未显示下降。总之，IgA肾病患儿似乎没有良性的临床病程。有蛋白尿的男孩在随访期间肾功能显著下降。
