Inoue Chiyoko N, Matsutani Sachiko, Ishidoya Masako, Homma Rikako, Chiba Yasushi, Nagasaka Takako
Department of Pediatrics, Department of Otolaryngology, Red Cross Sendai Hospital, Sendai, Japan.
Clin Nephrol. 2012 Feb;77(2):137-45. doi: 10.5414/CN106836.
We previously reported the efficacy of extensive eradication of infectious foci in oral and ENT lesions, combined with tonsillectomy plus methylprednisolone (MP) pulse therapy, for curing pediatric Henoch-Schönlein purpura (HSP) and HSP nephritis. In the present study, we used this therapy in patients with pediatric IgA nephropathy (IgAN) to assess whether similar results could be obtained.
In 11 pediatric patients newly diagnosed with IgAN, exploration for infectious foci showed severe oral infection, including dental caries and apical periodontitis, in many. The overall decayed, missing and filled teeth score was elevated to 5.91. Two patients had rhinosinusitis. After extensive treatment of infectious foci, patients underwent tonsillectomy plus MP pulse therapy with angiotensin II receptor blockade.
Clinical remission was achieved in all patients with pediatric IgAN (various histologic grades). Remission was achieved by 7.2 ± 5.7 months after initiation of steroid therapy, and disappearance of proteinuria by 3.3 ± 3.0 months. The mean duration of oral steroid administration was 9.5 ± 3.6 months. No relapse has occurred during follow-up of 4.3 ± 2.4 y.
Careful examination and thorough elimination of infectious foci in oral and ENT lesions can optimize the effect of tonsillectomy plus MP pulse therapy, promoting recovery from IgAN.
我们之前报道了广泛根除口腔和耳鼻喉病变中的感染灶，联合扁桃体切除术加甲基强的松龙（MP）冲击疗法，用于治疗小儿过敏性紫癜（HSP）和HSP肾炎的疗效。在本研究中，我们将这种疗法用于小儿IgA肾病（IgAN）患者，以评估是否能获得类似结果。
在11例新诊断为IgAN的小儿患者中，对感染灶的探查显示许多患者存在严重的口腔感染，包括龋齿和根尖周炎。龋失补牙面总分升至5.91。2例患者患有鼻窦炎。在对感染灶进行广泛治疗后，患者接受了扁桃体切除术加MP冲击疗法及血管紧张素II受体阻滞剂治疗。
所有小儿IgAN患者（各种组织学分级）均实现临床缓解。激素治疗开始后7.2±5.7个月实现缓解，蛋白尿消失时间为3.3±3.0个月。口服激素的平均给药时间为9.5±3.6个月。在4.3±2.4年的随访期间未发生复发。
仔细检查并彻底消除口腔和耳鼻喉病变中的感染灶可优化扁桃体切除术加MP冲击疗法的效果，促进IgAN的恢复。
