Kamei Koichi, Nakanishi Koichi, Ito Shuichi, Ishikura Kenji, Hataya Hiroshi, Honda Masataka, Nozu Kandai, Iijima Kazumoto, Shima Yuko, Yoshikawa Norishige
Department of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, 157-8535, Setagaya-ku, Tokyo, Japan,
Pediatr Nephrol. 2015 Jun;30(6):961-7. doi: 10.1007/s00467-014-3019-9. Epub 2014 Dec 10.
Although a 2-year combination therapy is effective for severe childhood immunoglobulin A (IgA) nephropathy, proteinuria persists in some patients even after the treatment.
Seventy-nine patients aged <18 years with IgA nephropathy in which >80 % of glomeruli showed mesangial proliferation were enrolled in the study. Risk factors for persistent proteinuria after combination therapy were investigated using multivariate logistic regression analysis.
Proteinuria (≥0.2 g/1.73 m(2)/day) persisted in 27 patients (34 %) after the combination therapy. Twenty-four-hour urinary protein excretion, rate of glomeruli with crescents, rate of glomeruli with segmental sclerosis and rate of glomeruli with global sclerosis at diagnosis were higher in patients with persistent proteinuria than those without. In the multivariate analysis, 24-h urinary protein excretion [odds ratio (OR) 6.9; 95 % confidence interval (CI) 2.1-27.8; p = 0.001] and rate of glomeruli with crescents (OR 3.8; 95 % CI 1.1-13.9; p = 0.03) were independent risk factors for persistent proteinuria. Analysis of the receiver operating characteristic curve demonstrated that the most accurate cut-off values to detect persistent proteinuria were a urinary protein excretion of 1.32 g/1.73 m(2)/day and a 14 % rate of glomeruli with crescents.
In our cohort, urinary protein excretion and rate of glomeruli with crescents at diagnosis were independent risk factors for persistent proteinuria after the combination therapy.
尽管为期2年的联合治疗对重度儿童免疫球蛋白A（IgA）肾病有效，但部分患者即使在治疗后蛋白尿仍持续存在。
本研究纳入了79例年龄<18岁的IgA肾病患者，其中超过80%的肾小球显示系膜增生。采用多因素逻辑回归分析研究联合治疗后蛋白尿持续存在的危险因素。
联合治疗后，27例患者（34%）蛋白尿（≥0.2 g/1.73 m²/天）持续存在。持续性蛋白尿患者诊断时的24小时尿蛋白排泄量、新月体肾小球率、节段性硬化肾小球率和球性硬化肾小球率均高于无持续性蛋白尿的患者。多因素分析显示，24小时尿蛋白排泄量[比值比（OR）6.9；95%置信区间（CI）2.1 - 27.8；p = 0.001]和新月体肾小球率（OR 3.8；95% CI 1.1 - 13.9；p = 0.03）是蛋白尿持续存在的独立危险因素。受试者工作特征曲线分析表明，检测持续性蛋白尿最准确的截断值为尿蛋白排泄量1.32 g/1.73 m²/天和新月体肾小球率14%。
在我们的队列中，诊断时的尿蛋白排泄量和新月体肾小球率是联合治疗后蛋白尿持续存在的独立危险因素。
