Vanherweghem J L, Abramowicz D, Tielemans C, Depierreux M
Department of Nephrology, Cliniques Universitaires de Bruxelles, Hôpital Erasme, Université Libre de Bruxelles, Belgium.
Am J Kidney Dis. 1996 Feb;27(2):209-15. doi: 10.1016/s0272-6386(96)90542-9.
Chinese herbs nephropathy is characterized by an extensive interstitial fibrosis and by a rapid evolution to end-stage renal failure. We thus decided to try steroid therapy (prednisolone 1 mg/kg for 1 month, tapered off 0.1 mg/kg every 2 weeks) in cases with moderate renal failure and evidence of deterioration in renal function. Our steroid group (SG) consisted of 12 female patients with biopsy-proven renal fibrosis who were followed for at least 12 months after the initiation of steroids. Plasma creatinine level (Pcreat) ranged from 1.8 to 3.9 mg/dL (mean +/- SEM, 2.8 +/- 0.2 mg/dL) when steroids were initiated at t = 0. Renal failure was in progression since Pcreat was 2.1 +/- 0.1 mg/dL (P = 0.022) 3 months before t = 0. Our control group (CG; N = 23) was selected retrospectively from among the 81 patients in the Belgian Register of Chinese Herbs Nephropathy. Compared with the CG, renal function was better preserved in the SG (Pcreat; mean +/- SEM): SG v CG, 2.9 +/- 0.3 mg/dL v 5.3 +/- 0.5 mg/dL at 6 months (P = 0.0024) and 4.0 +/- 0.7 mg/dL v 7.1 +/- 0.5 mg/dL at 1 year (P = 0.001). The slope of the reciprocal serum creatinine concentration was similar in both groups before t = 0 (-0.0463 mg/dL/mo in the SG v -0.0438 mg/dL/mo in the CG; P = 0.83), but it became less steep after initiation of steroid therapy (between 0 and 6 months, -0.000742 mg/dL/mo in the SG v -0.0284 mg/dL/mo in the CG; P < 0.001). Finally, only two of the 12 patients in the SG required dialysis at 1 year compared with 16 of the 23 patients in the CG (P = 0.0045). We conclude that steroid therapy slows the progression of renal failure in a disease characterized by an interstitial fibrosis that progresses quickly despite the fact that the insulting agent has been withdrawn. This supports the hypothesis that renal interstitial fibrosis may be an immune-mediated process.
中草药肾病的特征是广泛的间质纤维化以及迅速发展至终末期肾衰竭。因此，我们决定对中度肾衰竭且有肾功能恶化证据的患者尝试使用类固醇疗法（泼尼松龙1 mg/kg，持续1个月，每2周减量0.1 mg/kg）。我们的类固醇治疗组（SG）由12名经活检证实有肾纤维化的女性患者组成，在开始使用类固醇后至少随访12个月。在t = 0开始使用类固醇时，血浆肌酐水平（Pcreat）范围为1.8至3.9 mg/dL（均值±标准误，2.8±0.2 mg/dL）。在t = 0前3个月，Pcreat为2.1±0.1 mg/dL（P = 0.022），肾功能一直在进展。我们的对照组（CG；N = 23）是从比利时中草药肾病登记册中的81名患者中回顾性选取的。与CG相比，SG组的肾功能得到了更好的保留（Pcreat；均值±标准误）：SG组与CG组相比，6个月时分别为2.9±0.3 mg/dL和5.3±0.5 mg/dL（P = 0.0024），1年时分别为4.0±0.7 mg/dL和7.1±0.5 mg/dL（P = 0.001）。在t = 0之前，两组血清肌酐浓度倒数的斜率相似（SG组为-0.0463 mg/dL/月，CG组为-0.0438 mg/dL/月；P = 0.83），但在开始类固醇治疗后变得没那么陡（在0至6个月之间，SG组为-0.000742 mg/dL/月，CG组为-0.0284 mg/dL/月；P < 0.001）。最后，SG组的12名患者中只有2名在1年时需要透析，而CG组的23名患者中有16名需要透析（P = 0.0045）。我们得出结论，在一种以间质纤维化尽管致病因素已去除仍迅速进展为特征的疾病中，类固醇疗法可减缓肾衰竭的进展。这支持了肾间质纤维化可能是一种免疫介导过程的假说。
