Zheng Yue, He Xuehui, Hou Ling, Wang Xiuli, Zhao Chengguang, Du Yue
Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
Front Pediatr. 2022 Oct 13;10:992862. doi: 10.3389/fped.2022.992862. eCollection 2022.
The present study aimed to explore the relationship between nephrotic syndrome and atopic diseases in childhood.
From 2018 to 2019, 234 children with first-onset primary nephrotic syndrome (PNS) were selected for observation and long-term follow-up, and the clinical and laboratory data. To compare the levels of total serum IgE, histamine and bradykinin of the same children at the time of first onset, remission and relapse of PNS. The extent of podocyte foot process effacement was compared between the urinary protein negative-conversion group and the proteinuric group with the NS range. The correlation between the urine protein quantification and the extent of foot process effacement was also observed.
(1) The mean age of 234 children with first-onset PNS was 4.82 ± 3.63 years, with a male to female ratio of 162/72. (2) There were 109 cases (46.58%) with concomitant atopic diseases (AD) and 151 cases (64.53%) with elevated levels of total serum IgE. There were 136 cases with recurrence during the follow-up, of which recurrence due to allergy-related factors was greater than that due to infection-related factors. (3) The total IgE and bradykinin serum levels were significantly higher in children with first-onset PNS and recurrent PNS compared with those in remission, and the differences were statistically significant ( < 0.05). The level of histamine in children with first-onset PNS was higher than that in children with remission ( < 0.05), and there was no significant difference in the level of histamine between children in the recurrence group and those in the remission group ( > 0.05). (4) There was no significant difference in the extent of foot process effacement between the urinary protein negative-conversion group and the proteinuric group with the NS range. There was no significant correlation between the proteinuria quantification and the extent of foot process effacement.
There existed a high co-morbidity with AD in children with PNS, and allergy-related factors might be an important recurrence factor in children with PNS. The injury to the filtration barrier in MCD might not only be correlated with podocyte lesions but also with some serum permeability factors. Serum IgE, histamine, and bradykinin might be the plasma permeability factors in children with PNS.
本研究旨在探讨儿童肾病综合征与特应性疾病之间的关系。
选取2018年至2019年首次发病的234例原发性肾病综合征（PNS）患儿进行观察及长期随访，并收集其临床和实验室数据。比较同一批患儿在PNS首次发病、缓解及复发时血清总IgE、组胺和缓激肽水平。比较尿蛋白转阴组与NS范围内蛋白尿组足细胞足突消失程度。同时观察尿蛋白定量与足突消失程度之间的相关性。
（1）234例首次发病的PNS患儿平均年龄为4.82±3.63岁，男女比例为162/72。（2）109例（46.58%）伴有特应性疾病（AD），151例（64.53%）血清总IgE水平升高。随访期间有136例复发，其中因过敏相关因素复发的比例高于感染相关因素。（3）首次发病的PNS患儿及复发的PNS患儿血清总IgE和缓激肽水平明显高于缓解期患儿，差异有统计学意义（<0.05）。首次发病的PNS患儿组胺水平高于缓解期患儿（<0.05），复发组患儿与缓解期患儿组胺水平差异无统计学意义（>0.05）。（4）尿蛋白转阴组与NS范围内蛋白尿组足突消失程度差异无统计学意义。蛋白尿定量与足突消失程度无明显相关性。
PNS患儿中AD的共病率较高，过敏相关因素可能是PNS患儿重要的复发因素。微小病变性肾病滤过屏障损伤可能不仅与足细胞病变有关，还与某些血清通透性因子有关。血清IgE、组胺和缓激肽可能是PNS患儿的血浆通透性因子。
