儿童期特发性肾病综合征发生慢性肾脏病的时间和预测因素：亚洲经验。

Timing and predictive factors of developing chronic kidney disease in childhood-onset idiopathic nephrotic syndrome: an Asian experience.

机构信息

Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Hospital Universiti Sains Malaysia, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia.

出版信息

Singapore Med J. 2020 Sep;61(9):483-486. doi: 10.11622/smedj.2019096. Epub 2019 Sep 6.

DOI:10.11622/smedj.2019096

PMID:31489435

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7927174/

Abstract

INTRODUCTION

Idiopathic nephrotic syndrome (INS) is the commonest type of nephrotic syndrome in children, and a majority of cases have favourable outcomes. A small proportion of INS cases progress to chronic kidney disease (CKD). We investigated the time to CKD and predictive risk factors associated with progression of CKD in these children.

METHODS

A retrospective review of medical records was done to investigate the demographic variables, and biochemical and histological changes in children with INS aged 12 months to 18 years between 2001 and 2016 at Hospital Universiti Sains Malaysia. The median renal survival time for progression to CKD stage III or higher was determined using survival curve analysis. Multiple Cox regression analysis was used to identify predictive factors for CKD.

RESULTS

The total number of participants was 112 (boys: n = 71; girls: n = 41) and a majority had steroid-sensitive INS. Only about 10% of INS progressed to CKD Stage III or higher, with an overall median renal survival time of 19 years. Median renal survival time in steroid-resistant nephrotic syndrome (SRNS) was 13 years. Focal segmental glomerulosclerosis was predominant in SRNS. The predictors of progression to CKD were steroid resistance (adjusted hazard ratio [HR] [95% confidence interval (CI)] 23.8 [2.8-200.9]) and the presence of hypertension at presentation (adjusted HR [95% CI] 8.1 [1.2-55.7]).

CONCLUSION

The median renal survival time in our study was comparable to other studies. SRNS and the presence of hypertension at presentation were the main predictors for developing CKD in our population.

摘要

简介

特发性肾病综合征（INS）是儿童中最常见的肾病综合征类型，大多数病例的预后良好。少数 INS 病例会进展为慢性肾脏病（CKD）。我们研究了这些儿童发生 CKD 的时间以及与 CKD 进展相关的预测风险因素。

方法

对 2001 年至 2016 年在马来西亚大学医院就诊的年龄在 12 个月至 18 岁之间的特发性肾病综合征患儿的病历进行回顾性分析，以调查其人口统计学变量、生化和组织学变化。采用生存曲线分析确定进展为 CKD Ⅲ期或更高阶段的中位肾脏生存时间。采用多因素 Cox 回归分析确定 CKD 的预测因素。

结果

共有 112 名参与者（男孩：n = 71；女孩：n = 41），其中大多数为激素敏感型 INS。只有约 10%的 INS 进展为 CKD Ⅲ期或更高阶段，整体中位肾脏生存时间为 19 年。激素抵抗性肾病综合征（SRNS）的中位肾脏生存时间为 13 年。FSGS 是 SRNS 的主要表现。进展为 CKD 的预测因素是激素抵抗（调整后的危险比[HR] [95%置信区间（CI）] 23.8 [2.8-200.9]）和初诊时存在高血压（调整后的 HR [95% CI] 8.1 [1.2-55.7]）。