Idelson B A, Smithline N, Smith G W, Harrington J T
Arch Intern Med. 1977 Jul;137(7):891-6.
This long-term study analyzes the prognostic value of the quantitative urinary protein excretion during and following steroid administration, the renal functional status three years after the onset of disease, and the degree of histologic damage in adult patients with steroid-treated idiopathic nephrotic syndrome (INS). No patient who had a complete (proteinuria less than 0.1 gm/day) or partial (proteinuria less than 2.0 gm/day) remission during steroid administration progressed to renal failure. Furthermore, no patient in whom urinary protein excretion subsequently fell to below 2.0 gm/day ever progressed to renal failure. Only 3 of 49 patients in whom renal function was normal three years after the onset of INS developed renal failure. Finally, renal failure occurred in only 2 of 28 patients with mild abnormalities by light microscopy, compared with 12 of 21 patients with more advanced glomerular abnormalities. Thus, a partial, as well as a complete remission during steroid administration, subsequent reduction in proteinuria to below 2 gm/day, persistence of normal renal function beyond three years, or the presence of mild histologic abnormalities auger a favorable long-term prognosis in patients with INS.
这项长期研究分析了成年特发性肾病综合征（INS）患者在使用类固醇期间及之后尿蛋白定量排泄的预后价值、疾病发作三年后的肾功能状况以及组织学损伤程度。在使用类固醇期间完全缓解（蛋白尿少于0.1克/天）或部分缓解（蛋白尿少于2.0克/天）的患者均未进展至肾衰竭。此外，随后尿蛋白排泄降至2.0克/天以下的患者也从未进展至肾衰竭。在INS发病三年后肾功能正常的49例患者中，只有3例发生了肾衰竭。最后，在28例经光学显微镜检查仅有轻度异常的患者中，只有2例发生了肾衰竭，而在21例肾小球异常更严重的患者中，有12例发生了肾衰竭。因此，在使用类固醇期间部分缓解以及完全缓解、随后蛋白尿降至2克/天以下、肾功能在三年后仍保持正常或存在轻度组织学异常，均预示着INS患者长期预后良好。
