Qi Feifan, Zeng Hui-Qin, Zhu Lin, Zhou Ping, Zhang Jian-Jiang
Department of Pediatrics, Clinical Center of Pediatric Nephrology of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
Department of Pediatric Nephrology and Rheumatology, Sichuan Provincial Maternity and Child Health Care Hospital, The Affiliated Women's and Children's Hospital of Chengdu Medical College, Chengdu, 610045, Sichuan, China.
J Nephrol. 2025 Jan 3. doi: 10.1007/s40620-024-02175-4.
One of the most common secondary glomerular diseases in children is IgA vasculitis-associated nephritis (IgAVN). Determining the best treatment for IgAVN based on current guidelines is controversial. The purpose of this study was to evaluate the efficacy of methylprednisolone pulse therapy in Chinese children with moderate and severe IgAVN.
We compared outcomes between 86 children with IgAVN who received methylprednisolone pulse therapy (40 patients) and those who did not (46 patients). Both groups of patients were monitored for a minimum of one year. Laboratory results including 24-h proteinuria, serum albumin, serum creatinine, and clinical symptoms including edema and adverse reactions were compared.
The average age of the children in the group receiving methylprednisolone pulse therapy was 8.71 ± 2.71 years, while the average age in those who did not receive pulse therapy was 8.48 ± 3.02 years. Methylprednisolone pulse treatment resulted in a longer-lasting reduction in urinary protein levels and in reduced recurrence rates and increased remission rates at 3 and 6 months (methylprednisolone: 65% and 85% versus no methylprednisolone: 43.48% and 67.39%, respectively). The recurrence rate within one year also differed significantly between the two groups. Within one year, 25% of children receiving methylprednisolone pulse therapy relapsed, whereas 43.5% of children not receiving methylprednisolone pulse therapy relapsed.
In Chinese children with moderate to severe IgAVN, methylprednisolone pulse therapy achieved a significantly higher remission rate and a more rapid eGFR improvement than non-methylprednisolone pulse therapy. Prompt initiation of methylprednisolone pulse therapy for children diagnosed with moderate to severe IgAVN may therefore be recommended.
儿童最常见的继发性肾小球疾病之一是IgA血管炎相关性肾炎（IgAVN）。根据当前指南确定IgAVN的最佳治疗方法存在争议。本研究的目的是评估甲泼尼龙冲击疗法对中国中重度IgAVN儿童的疗效。
我们比较了86例接受甲泼尼龙冲击疗法的IgAVN儿童（40例）和未接受该疗法的儿童（46例）的治疗结果。两组患者均至少监测一年。比较了包括24小时蛋白尿、血清白蛋白、血清肌酐在内的实验室结果以及包括水肿和不良反应在内的临床症状。
接受甲泼尼龙冲击疗法的儿童平均年龄为8.71±2.71岁，而未接受冲击疗法的儿童平均年龄为8.48±3.02岁。甲泼尼龙冲击治疗使尿蛋白水平持续降低，复发率降低，3个月和6个月时的缓解率提高（甲泼尼龙组：分别为65%和85%，未用甲泼尼龙组：分别为43.48%和67.39%）。两组一年内的复发率也有显著差异。一年内，接受甲泼尼龙冲击疗法的儿童中有25%复发，而未接受甲泼尼龙冲击疗法的儿童中有43.5%复发。
在中国中重度IgAVN儿童中，甲泼尼龙冲击疗法比非甲泼尼龙冲击疗法的缓解率显著更高，eGFR改善更快。因此，对于诊断为中重度IgAVN的儿童，建议尽早开始甲泼尼龙冲击疗法。
