Zidar N, Avgustin Cavić M, Kenda R B, Ferluga D
Medical Faculty, University of Ljubljana, and Department of Pediatric Nephrology, University Medical Centre, Slovenia.
Kidney Int. 1998 Oct;54(4):1320-3. doi: 10.1046/j.1523-1755.1998.00121.x.
Intrauterine growth retardation (IUGR) is associated with higher morbidity and mortality not only in perinatal life but also in later life. The purpose of our study was to determine whether IUGR has any effect on the course of minimal change nephrotic syndrome (MCNS) in children.
Forty children who were between 1 and 16 years old at the onset of MCNS, who have been followed for at least three years and for whom we were able to obtain birth weights and gestational ages, were included. The diagnosis of MCNS was predicted on the basis of clinical and laboratory features, and in 11 children (27.5%) the diagnosis was confirmed by renal biopsy. IUGR was defined as birth weight below the tenth percentile for gestational age.
Five children (12.5%) had signs of IUGR at birth. In children with IUGR, we observed a higher mean number of relapses (10.4 vs. 3.3, P < 0.001) and a higher incidence of steroid dependency (80% vs. 21%, P < 0.02) than in children without IUGR. Other differences between children with and those without IUGR included more frequent treatment with cytotoxic agents and cyclosporine, and a higher incidence of renal biopsy in children with IUGR.
Our study demonstrated an unfavorable course of MCNS in children with IUGR. IUGR could therefore enable early identification of those children who are at risk of becoming frequent relapsers and of developing steroid dependency. This, however, should be confirmed in a larger number of patients.
宫内生长受限（IUGR）不仅与围产期较高的发病率和死亡率相关，还与后期生活中的这些情况有关。我们研究的目的是确定IUGR是否对儿童微小病变肾病（MCNS）的病程有任何影响。
纳入40名在MCNS发病时年龄在1至16岁之间、至少随访三年且我们能够获取其出生体重和孕周的儿童。MCNS的诊断基于临床和实验室特征进行预测，11名儿童（27.5%）的诊断通过肾活检得以证实。IUGR定义为出生体重低于孕周对应的第十百分位数。
5名儿童（12.5%）出生时具有IUGR体征。与无IUGR的儿童相比，我们观察到IUGR儿童的平均复发次数更高（10.4比3.3，P<0.001），类固醇依赖的发生率更高（80%比21%，P<0.02）。有IUGR和无IUGR儿童之间的其他差异包括使用细胞毒性药物和环孢素治疗更频繁，以及IUGR儿童肾活检的发生率更高。
我们的研究表明IUGR儿童的MCNS病程不利。因此，IUGR可使早期识别出那些有频繁复发风险和发生类固醇依赖风险的儿童。然而，这一点应在更多患者中得到证实。
