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幼年特发性关节炎患儿队列中慢性肾脏病和高血压的患病率及相关因素。

Prevalence of and factors associated to chronic kidney disease and hypertension in a cohort of children with juvenile idiopathic arthritis.

机构信息

Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy.

出版信息

Eur J Pediatr. 2021 Feb;180(2):655-661. doi: 10.1007/s00431-020-03792-4. Epub 2020 Aug 29.

Abstract

We evaluated chronic kidney disease (CKD) (proteinuria or estimated glomerular filtration rate < 60 mL/min/1.73 m) or hypertension prevalence in 110 children with juvenile idiopathic arthritis (JIA). CKD and hypertension were clustered under the umbrella term of "renal injury". Median age at the last visit was 14 years. Nine out of 110 (8.1%) patients showed renal injury (8 hypertension, 1 proteinuria). Patients with renal injury presented higher age at last visit, longer duration of active JIA, shorter intervals free from JIA relapses, longer duration of non-steroidal anti-inflammatory drugs (NSAIDs) treatment but with similar cumulative NSAIDs dose and higher rate of methotrexate (MTX) prescription, longer time of MTX administration, and higher cumulative MTX dose compared to patients without renal injury. At the last visit, patients with and without renal injury presented similar prevalence of active disease. The cumulative proportion of patients free from renal injury at 240 months since JIA onset was 40.72% for all population; while the cumulative proportion was 23.7% for patients undergoing NSAIDs+MTX treatment and 100% for those undergoing NSAIDs (p = 0.039) treatment.Conclusion:About 8% of the children with JIA develop hypertension or CKD. The main risk factor was longer exposure to both NSAIDs and MTX due to a more severe form of the disease. What is Known •Anecdotal reports showed that rarely juvenile idiopathic arthritis (JIA) could present renal involvement due to prolonged and uncontrolled inflammation (renal amyloidosis) or to long exposure to anti-rheumatic drugs. •No cohort studies investigated renal health in children with JIA. What is new •About 8% of the children with JIA developed hypertension or chronic kidney disease. •The main risk factor was long exposure to non-steroidal anti-inflammatory drugs and methotrexate for patients suffering from a more severe form of the disease. •In JIA patients, periodic evaluation of renal function, blood pressure and proteinuria should be warranted.

摘要

我们评估了 110 名青少年特发性关节炎 (JIA) 儿童的慢性肾脏病 (CKD) (蛋白尿或估计肾小球滤过率 < 60 mL/min/1.73 m) 或高血压患病率。CKD 和高血压被归为“肾损伤”这一伞式术语下。最后一次就诊时的中位年龄为 14 岁。110 名患者中有 9 名(8.1%)出现肾损伤(8 名高血压,1 名蛋白尿)。有肾损伤的患者最后一次就诊时年龄较大,活动性 JIA 持续时间较长,无 JIA 复发的间隔较短,非甾体抗炎药(NSAIDs)治疗时间较长,但累积 NSAIDs 剂量相似,且甲氨蝶呤(MTX)处方率较高,MTX 给药时间较长,累积 MTX 剂量较高。与无肾损伤的患者相比。最后一次就诊时,有肾损伤和无肾损伤的患者活动性疾病的患病率相似。自 JIA 发病以来 240 个月无肾损伤的患者累积比例为所有人群的 40.72%;而接受 NSAIDs+MTX 治疗的患者累积比例为 23.7%,接受 NSAIDs 治疗的患者为 100%(p = 0.039)。结论:约 8%的 JIA 患儿会发展为高血压或 CKD。主要危险因素是由于疾病更严重,两种 NSAIDs 和 MTX 的暴露时间更长。已知:一些传闻报道称,青少年特发性关节炎 (JIA) 很少因长期且不受控制的炎症(肾淀粉样变性)或长期使用抗风湿药物而导致肾脏受累。没有队列研究调查 JIA 儿童的肾脏健康状况。新内容:约 8%的 JIA 患儿会发展为高血压或慢性肾脏病。主要危险因素是疾病更严重的患者长期接触非甾体抗炎药和甲氨蝶呤。在 JIA 患者中,应定期评估肾功能、血压和蛋白尿。

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