Ito K, Kawaguchi H, Hattori M
Department of Pediatric Nephrology, Tokyo Women's Medical College, Japan.
Acta Paediatr Jpn. 1990 Dec;32(6):710-5. doi: 10.1111/j.1442-200x.1990.tb00909.x.
In this study we evaluated the incidence of chronic renal failure in children with asymptomatic proteinuria and/or hematuria detected by a mass screening program in school and kindergarten. A total of four thousand and three children, aged from 2 to 18 years old was referred to our institute between 1977 and 1990. Of them, 4 cases were AGN, 8 cases Alports' syndrome, 7 cases FGN, 7 cases F(s)GS, 3 cases HSPN, 148 cases IgA nephropathy, 12 cases MN, 24 cases MPGN (including 7 cases of focal type MPGN), 1 case lupus nephritis, and others. Of these children 2 of 8 cases of Alports' syndrome, one of 7 cases of FGS, 6 of 148 cases of IgA nephropathy and none of 24 cases of MPGN developed chronic renal failure. It is true that the incidence of chronic renal failure in children with various kinds of renal disease detected by a mass screening program is lower than that of symptomatic children. However, since we do not have yet any specific treatment in most cases and also since the follow-up period is not long enough, the definite conclusion that a mass screening program can alter the prognosis of children with renal diseases cannot be drawn except for some particular lesions such as MPGN, especially the focal type. Further study including a much larger population of patients is necessary.
在本研究中，我们评估了通过学校和幼儿园大规模筛查项目检测出的无症状蛋白尿和/或血尿儿童的慢性肾衰竭发生率。1977年至1990年间，共有4003名年龄在2至18岁的儿童被转诊至我院。其中，4例为急性肾小球肾炎（AGN），8例为Alport综合征，7例为局灶节段性肾小球硬化（FSGS），7例为系膜增生性肾小球肾炎（MsPGN），3例为紫癜性肾炎（HSPN），148例为IgA肾病，12例为膜性肾病（MN），24例为膜增生性肾小球肾炎（MPGN，包括7例局灶性MPGN），1例为狼疮性肾炎，以及其他病例。在这些儿童中，8例Alport综合征中有2例、7例FSGS中有1例、148例IgA肾病中有6例以及24例MPGN中无一例发展为慢性肾衰竭。通过大规模筛查项目检测出的患有各种肾病的儿童中慢性肾衰竭的发生率确实低于有症状儿童。然而，由于在大多数情况下我们尚无任何特异性治疗方法，且随访期也不够长，除了一些特殊病变如MPGN（尤其是局灶性类型）外，无法得出大规模筛查项目可改变肾病儿童预后的明确结论。有必要开展包括更多患者人群的进一步研究。
