Department of Nephrology, Beijing Children's Hospital affiliated with Capital Medical University, West District Nan Li Shi Lu 56th, Beijing, 100045, China.
Pediatr Nephrol. 2018 Jul;33(7):1183-1187. doi: 10.1007/s00467-018-3885-7. Epub 2018 Mar 22.
The level of urinary cluster of differentiation 80 (uCD80) is elevated in most children with minimal change disease (MCD) as opposed to focal segmental glomerulosclerosis (FSGS) during the acute phase. The objective of this follow-up study was to evaluate whether uCD80 elevation is actually associated with MCD and whether it signals better prognosis.
We evaluated uCD80 levels and a series of putative progression factors in a cohort of 64 patients with nephrotic syndrome (NS) seen between 2011 and 2016. We monitored progression of chronic kidney disease (CKD), assessed as a glomerular filtration rate of < 90 ml/min/1.73 m for at least 3 months. Patients were classified according to uCD80 level and to the progression rate as calculated by Kaplan-Meier survival analysis and Cox's regression analysis.
During a mean follow-up period of 4.8 ± 0.6 (range 3.5-6.0) years, 13 children (20%) evolved to at least CKD stage 2. The 64 patients with NS and normal baseline renal function were divided into two groups based on uCD80 excretion, i.e. below or above a defined cutoff (< or > 328.98 ng/g creatinine). The predicted response to immunosuppression therapy was 34.5 and 100% in the low- and high-uCD80 excretion, respectively (p < 0.001). Progression to CKD was 41.4 vs. 2.9% in NS patients (p < 0.001). Using the Cox model, only uCD80 excretion (p = 0.013, relative risk 6.171) predicted progression to CKD.
Urinary CD80 predicts progression and remission in children with NS. The use of uCD80 as a prognostic marker facilitates the identification of high-risk patients at an early stage and may lead to better treatment selection.
在急性阶段，大多数微小病变性肾病（MCD）患儿的尿分化群 80（uCD80）水平升高，而局灶节段性肾小球硬化症（FSGS）患儿则相反。本随访研究的目的是评估 uCD80 升高是否与 MCD 有关，以及它是否预示着更好的预后。
我们评估了 64 例肾病综合征（NS）患儿的 uCD80 水平和一系列潜在的进展因素，这些患儿于 2011 年至 2016 年就诊。我们监测了慢性肾脏病（CKD）的进展，定义为肾小球滤过率（GFR）<90 ml/min/1.73 m 至少 3 个月。根据 uCD80 水平和 Kaplan-Meier 生存分析和 Cox 回归分析计算的进展率，将患者进行分类。
在平均 4.8±0.6（范围 3.5-6.0）年的随访期间，13 名儿童（20%）进展为至少 CKD 2 期。64 例初诊时肾功能正常的 NS 患儿根据 uCD80 排泄量分为两组，即低于或高于定义的截点（<或>328.98ng/g 肌酐）。低 uCD80 排泄组和高 uCD80 排泄组的免疫抑制治疗反应预测值分别为 34.5%和 100%（p<0.001）。NS 患者中进展为 CKD 的比例分别为 41.4%和 2.9%（p<0.001）。使用 Cox 模型，只有 uCD80 排泄（p=0.013，相对危险度 6.171）预测了 CKD 的进展。
尿 CD80 可预测儿童 NS 的进展和缓解。将 uCD80 用作预后标志物有助于在早期识别高危患者，并可能导致更好的治疗选择。
