Sancewicz-Pach K
Kliniki Nefrologii Dzieciecej Instytutu Pediatrii Akademii Medycznej im. M. Kopernika, Krakowie.
Folia Med Cracov. 1990;31(4):17-49.
None of the clinical symptoms of the nephrotic syndrome including the age and sex of the sick child as the presence or absence of immunologic markers, and even kidney morphology results explains the fact why in similar situation the course of the nephrotic syndrome in some children is of poor prognosis whereas in others of a good one. The objective of the present study has been to prove that there are additional factors accounting for the course of the obtained remission. The author has had in mind mutagenic factors active during pregnancy in mothers of the children with the primary nephrotic syndrome. An attempt has been made to determine the relationship between the single or multiple occurrence of mutagenic factors and the remission type. The analysis included 250 children with the nephrotic syndrome treated in the years 1965-1985, their age being from 10 months up to 14 years. In the majority of the patients the diagnosis was made on the basis of the clinical picture and laboratory determinations. In 86 cases a renal biopsy was performed. Out of 250 children a complete remission was obtained in 125 cases (50%), and a partial one included 81 patients (32.4%). No remission was observed in 44 children (17.6%). Thirteen patients died (5.2%). The results of the studies have revealed that the presence of selected mutagenic factors e.g. the mother's age over 30 years, maternal diseases and "exposures" noted during pregnancy is closely related to the obtained remission type in the children with the nephrotic syndrome. In the group wherein single factors occurred 48.4% of mothers were over 30 years of age. In the group with two mutagenic factors a combination of maternal diseases and "exposures" was most frequent (52.7%). The mother's age, maternal diseases and "exposures" were the most common combination (73.9%) in the group with three mutagenic factors. The author has noted a positive correlation between the number of mutagenic factors occurring in mothers of the children with the nephrotic syndrome and the obtained degree of improvement. The theoretical likelihood of the lack of remission was increasing with the number of mutagenic factors. The above hypothesis has been confirmed by the relationship between the remission type and the frequency of mutagenic factors incidence in 86 children in whom a renal biopsy was performed. Regardless of the morphologic findings the likelihood of the lack of remission in the children with the nephrotic syndrome increases along with the number of simultaneously acting mutagenic factors.(ABSTRACT TRUNCATED AT 400 WORDS)
肾病综合征的临床症状，包括患病儿童的年龄和性别、免疫标志物的有无，甚至肾脏形态学结果，都无法解释为什么在类似情况下，一些儿童的肾病综合征病程预后较差，而另一些儿童的预后则良好。本研究的目的是证明存在其他因素影响缓解过程。作者考虑的是原发性肾病综合征患儿母亲孕期的诱变因素。已尝试确定诱变因素的单一或多次出现与缓解类型之间的关系。分析包括1965年至1985年期间接受治疗的250例肾病综合征患儿，年龄从10个月至14岁。大多数患者的诊断基于临床表现和实验室检查。86例进行了肾活检。250例患儿中，125例（50%）完全缓解，81例（32.4%）部分缓解。44例（17.6%）未缓解。13例死亡（5.2%）。研究结果表明，某些诱变因素的存在，如母亲年龄超过30岁、孕期的母体疾病和“暴露”，与肾病综合征患儿的缓解类型密切相关。在单一因素出现的组中，48.4%的母亲年龄超过30岁。在有两个诱变因素的组中，母体疾病和“暴露”的组合最为常见（52.7%）。在有三个诱变因素的组中，母亲年龄、母体疾病和“暴露”是最常见的组合（73.9%）。作者注意到肾病综合征患儿母亲中出现的诱变因素数量与获得的改善程度之间呈正相关。随着诱变因素数量的增加，无缓解的理论可能性也在增加。上述假设已通过对86例进行肾活检的患儿的缓解类型与诱变因素发生频率之间的关系得到证实。无论形态学结果如何，肾病综合征患儿无缓解的可能性随着同时作用的诱变因素数量的增加而增加。（摘要截选至400字）
