Department of Pediatrics, Okayama University Hospital.
Department of Pediatrics, Japanese Red Cross Okayama Hospital.
Acta Med Okayama. 2022 Feb;76(1):41-49. doi: 10.18926/AMO/63207.
High-dose steroids are required for the treatment of minimal change nephrotic syndrome (MCNS), especially for episodes of recurrence. Predicting and avoiding recurrence can help reduce the steroid dose, but prediction is currently difficult. We herein examined whether changes in laboratory data, especially the urinary protein- to-creatinine ratio (UTP/UCr), can predict clinical recurrence. We also assessed differences in clinical features between children and young adults. We included 36 patients with MCNS; for each case, we retrospectively studied laboratory data during stable remission and pre-recurrence, with the "stable" period defined as all but the 6 weeks before recurrence, and pre-recurrence defined as the 4±2 weeks before recurrence. UTP/UCr, serum albumin, etc. were measured every 5 years during stable periods. We divided patients into cohorts by age at recurrence, < 15 years and ≥ 15 years, and compared stable and pre-recurrence values for the two groups. UTP/UCr values during stable periods tended to be higher in younger patients. UTP/UCr and serum albumin showed statistically significant changes during pre-recurrence periods, but only in those aged ≥ 15 years. Thus, clinical features of recurrence differed depending on age. Signs of recurrence can be confirmed via UTP/UCr or serum albumin several weeks before recurrence in patients ≥ 15 years.
高剂量类固醇是治疗微小病变肾病综合征（MCNS）所必需的，尤其是对于复发的情况。预测和避免复发可以帮助减少类固醇的剂量，但目前预测仍然很困难。我们在此检查了实验室数据的变化，特别是尿蛋白与肌酐比值（UTP/UCr），是否可以预测临床复发。我们还评估了儿童和青年之间的临床特征差异。我们纳入了 36 例 MCNS 患者；对于每个病例，我们回顾性地研究了稳定缓解期和复发前期的实验室数据，“稳定”期定义为复发前的 6 周以外的所有时期，复发前期定义为复发前的 4±2 周。在稳定期，每 5 年测量一次 UTP/UCr、血清白蛋白等。我们根据复发时的年龄将患者分为<15 岁和≥15 岁两组，并比较了两组的稳定期和复发前期的值。稳定期的 UTP/UCr 值在年轻患者中倾向于更高。UTP/UCr 和血清白蛋白在复发前期都有统计学意义的变化，但仅在年龄≥15 岁的患者中。因此，复发的临床特征因年龄而异。在年龄≥15 岁的患者中，复发前数周即可通过 UTP/UCr 或血清白蛋白确认复发迹象。
