Al Romaili Duaa M, Al-Hussain Turki O, Awad Hazem S, Saadeh Sermin A, Al-Hassoun Ibrahim A, Al-Shareef Turki A
Department of Pediatric Nephrology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Department of Pathology and Laboratory Medicine- Anatomic Pathology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Int J Pediatr Adolesc Med. 2019 Dec;6(4):146-150. doi: 10.1016/j.ijpam.2019.09.001. Epub 2019 Sep 12.
Idiopathic nephrotic syndrome (INS) is a common pediatric disease. Minimal change disease (MCD) is the most common histopathological subtype and usually has good prognosis. However, in less common presentations, INS may have an unusual course that makes renal biopsy a necessity to identify its etiology. Immunoglobulin M (IgM) occasionally deposits in the mesangium and can be seen under immunofluorescence (IF). The role of IgM is controversial in MCD. It is likely associated with less favorable outcomes for MCD. This study aims to investigate the clinical significance of mesangial IgM deposits on the outcome of MCD in a pediatric population.
In this retrospective cohort study, we obtained native kidney biopsy samples from 192 children who were diagnosed with MCD from 2003 to 2014. The samples were divided into groups according to the histopathological deposition of IgM in biopsies under IF. The group for which biopsies showed IgM was labeled as IgM + IF (n = 77), and the group for which biopsies were without IgM was labeled as IgM-IF (n = 115). We reviewed hypertension, hematuria, and estimated glomerular filtration rate (eGFR) at the time of presentation to our institute; response to steroid therapy (remission, dependence, frequent relapses, and resistance) and response after adjuvant immunosuppressive therapy (complete remission, partial remission, frequent relapses, and no response) when indicated; development of chronic kidney disease (CKD) and end-stage renal disease during the course of the disease (ESRD).
Our results showed that mesangial IgM deposition in MCD showed significant statistical association with hypertension at the time of presentation ( = .05). There was statistically significant association between the presence of IgM deposition and the development of steroid dependence ( = .05) and CKD during the course of the disease ( = .05).
Our study showed that IgM deposition in MCD showed statistical association with hypertension by the time the patient presented to our institute, development of steroid dependence, and CKD. IgM may play a role in MCD. However, we recommend a prospective study to verify the role of IgM in MCD outcomes.
特发性肾病综合征（INS）是一种常见的儿科疾病。微小病变病（MCD）是最常见的组织病理学亚型，通常预后良好。然而，在不常见的表现中，INS可能有不寻常的病程，这使得肾活检成为确定其病因的必要手段。免疫球蛋白M（IgM）偶尔沉积于系膜，可在免疫荧光（IF）下观察到。IgM在MCD中的作用存在争议。它可能与MCD的不良预后相关。本研究旨在探讨系膜IgM沉积对儿科人群MCD预后的临床意义。
在这项回顾性队列研究中，我们获取了2003年至2014年期间诊断为MCD的192例儿童的肾活检样本。根据IF下活检中IgM的组织病理学沉积情况将样本分组。活检显示有IgM的组标记为IgM + IF（n = 77），活检无IgM的组标记为IgM-IF（n = 115）。我们回顾了患者就诊于我院时的高血压、血尿和估计肾小球滤过率（eGFR）；必要时回顾激素治疗反应（缓解、依赖、频繁复发和抵抗）以及辅助免疫抑制治疗后的反应（完全缓解、部分缓解、频繁复发和无反应）；疾病过程中慢性肾脏病（CKD）和终末期肾病（ESRD）的发生情况。
我们的结果显示，MCD中系膜IgM沉积与就诊时的高血压有显著统计学关联（P = 0.05）。IgM沉积的存在与疾病过程中激素依赖的发生（P = 0.05）和CKD有显著统计学关联（P = 0.05）。
我们的研究表明，MCD中IgM沉积与患者就诊于我院时的高血压、激素依赖的发生和CKD有统计学关联。IgM可能在MCD中起作用。然而，我们建议进行前瞻性研究以验证IgM在MCD预后中的作用。
