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Клинико-морфологические особенности и течение lgA-нефропатии у детей
УДК:
616-053.2
Автор статьи:
Наушабаева А Е.
Место работы автора:
Научный центр педиатрии и детской хирургии МЗ РК
Название журнала:
Педиатрия и детская хирургия
Год выпуска:
2009
Номер журнала:
2(56)
Страницы:
с.21-26
Резюме на казахском языке:
IgA-нефропатия ( Ig-HП) барлық елдерде де – гломерулопатиялардың ең жиiсi. Оның емi, әсiресе иммуносупрессия әсерi, әлi анықталмаған. 7-18 жастағы IgАНП-мен ауырған 15 баладағы ем қарастырылган. Клиникалық көрiнiстерi 1 балада тез удейтiн, 4 балада жедел нефритикалык синдроммен. 2-де – нефротикалық синдроммен, 2-де соңғы екi cиндром қосарлана, ал 6 балада протеинурия мен гематурия мен айқын болған. Морфологиялық тексергенде (НААS жiктелуi бойынша) 6 балада – 3 класс өзгерiстерi, 6-да – 4 класс, ал 3-де – 5 класс табылды. Барлық балаларда жалпы және селективтi иммуносупрессорлар нәтижесiнде экстраренальдық белгiлер кетiп, протеинурия мен фильтрация өзгерici азайды. АОФ ингибиторлары протеинурия мен гематурияның азаюына ықпал жасады. Сонымен ем IgA-НП-н ағымымы мен болжамын жақсартуға әсер етедi
Резюме на английском языке:
IgA-nephropathy (IgA-NP) is the most frequent glomerulopathy in all countries and is still therapeutic dilemma, particularly in instance of immunosuppressive drugs.An experience of treatment of 15 children with IgA-NP aged 7-18 was presented. The clinical manifestation of IgA-NP was: rapidly progressive glomerulonephritis in 1 , association of the nephritic (NiS) кешiand nephrotic (NS) syndromes in 2, NiS in 4, NS in 2, combination of proteinuria (PU) and hematuria (HU) in 6. Glomerular filtration rate (GFR) and PU in the debut of the disease were in average 74 ml/min and 2.5 g/d respectively.Morphologically (Haas classification), class 3 was established in 6, class 4 in 6 and class 5 in 3 patients. We have used consecuental treatment with immunosuppressors of general and selective action in all patients with disappearing of extrarenal signs, decreasing of PU and improvement of GFR which was seen in monotherapy with ACEi also.Thus, immunosuppressive therapy in combination with ACEi is effective in patients with IgA-NP and allows to improve the course and prognosis of the disease.
Список литературы:
1. Appel G.B., Waldman M. The IgA nephropathy treatment dilemma. Mini Review. Kidney International. 2006. 69; 1939 – 1944.
2. Barratt J., Feehally J. Treatment of IgA nephropathy. Kidney International. 2006. 69; 1934 – 1938.
3. Keith D.S., Nichols G.A., Gullion C.M. et al. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004. 164; 659 – 663.
4. Go A.S., Chertow G.M., Fan D. et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004. 351; 1296 – 1305.
5. Floege J. Recurrent IgA nephropathy after renal transplantation. Semin Nephrol. 2004. 24; 287 – 291.
6. Канатбаева А.Б. Клинико-патогенетическая оценка рецидивирующей гематурии у детей: дисс….докт. мед. наук.- М.,1982.
7. Pozzi C., Andrulli S., Del Vecchio L. et al. Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial. J Am Soc Nephrol. 2004. 15; 157 – 163.
8. Ballardie F.W., Roberts I.S.. Controlled prospective trial of prednisolone and cytotoxics in progressive IgA ne¬phropathy. J Am Soc Nephrol. 2002. 13; 142 – 148.
9. Tang S., Leung J.C., Chan L.Y. et al. Mycophenolate mofetil alleviates persistent proteinuria in IgA nephropathy. Kidney Int. 2005. 68; 802 – 812.
10. Tumlin J.A., Hennigar R.A.. Clinical presentation, natural history, and treatment of crescentic proliferative IgA nephropathy. Semin Nephrol. 2004. 24; 256 – 268.
11. Haas M., Jafri J., Bartosh S.M. et al. ANCA-associated crescentic glomerulonephritis with mesangial IgA deposits. Am J Kidney Dis. 2000. 36; 709 – 718.
12. Samuels J.A., Strippoli G.F., Craig J.C. et al. Immunosuppressive treatments for immunoglobulin A nephropathy: a meta-analysis of randomized controlled trials. Nephrology (Carlton). 2004. 9; 177 – 185.
13. Hogg R.J., Wyatt R.J. A randomized controlled trial of mycophenolate mofetil in patients with IgA nephropathy (ISRCTN6257616). BMC Nephrol. 2004. 5; 3.
14. Jafar T.H., Stark P.C., Schmid C.H. et al. Progression of chronic kidney disease: The role of blood pressure control, 139; 244 – 252.
15. Kanno Y., Okada H., Saruta T. et al. Blood pressure reduction associated with preservation of renal function in hypertensive patients with IgA nephropathy: a 3-year follow-up. Clin Nephrol. 2000. 54; 360 – 365.
16. Praga M., Gutierrez E., Gonzalez E. et al. Treatment of IgA nephropathy with ACE inhibitors: a randomized and controlled trial. J Am Soc Nephrol. 2003. 14; 1578 – 1583.
17. Nakao N., Yoshimura A., Morita H. et al. Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial. Lancet. 2003. 361; 117 – 124.
18. Strippoli G.F., Manno C., Schena F.P. An ‘evidence-based’ survey of therapeutic options for IgA nephropathy: assessment and criticism. Am J Kidney Dis. 2003. 41; 1129 – 1139.
19. Hogg R.J., Lee J., Narelli N. et al. Multicenter placebo-controlled trial of alternate day prednisolone or daily omega-3 fatty acids in children and young adults with IgA nephropathy. Report from the Southwest Pediatric Nephrology Study Group. J Am Soc Nephrol. 2003. 14; 751A.
20. Hotta O., Miyazaki M., Furuta T. et al. Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis. 2001. 38; 736 – 743.
21. Xie Y., Nishi S., Ueno M. et al. The efficacy of tonsillectomy on long-term renal survival in patients with IgA ne¬phropathy. Kidney Int. 2003. 63; 1861 – 1867.
22. Rasche F.M., Schwarz A., Keller F. Tonsillectomy does not prevent a progressive course in IgA nephropathy. Clin Nephrol. 1999. 51; 147 – 152.
1. Appel G.B., Waldman M. The IgA nephropathy treatment dilemma. Mini Review. Kidney International. 2006. 69; 1939 – 1944.
2. Barratt J., Feehally J. Treatment of IgA nephropathy. Kidney International. 2006. 69; 1934 – 1938.
3. Keith D.S., Nichols G.A., Gullion C.M. et al. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med. 2004. 164; 659 – 663.
4. Go A.S., Chertow G.M., Fan D. et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004. 351; 1296 – 1305.
5. Floege J. Recurrent IgA nephropathy after renal transplantation. Semin Nephrol. 2004. 24; 287 – 291.
6. Канатбаева А.Б. Клинико-патогенетическая оценка рецидивирующей гематурии у детей: дисс….докт. мед. наук.- М.,1982.
7. Pozzi C., Andrulli S., Del Vecchio L. et al. Corticosteroid effectiveness in IgA nephropathy: long-term results of a randomized, controlled trial. J Am Soc Nephrol. 2004. 15; 157 – 163.
8. Ballardie F.W., Roberts I.S.. Controlled prospective trial of prednisolone and cytotoxics in progressive IgA ne¬phropathy. J Am Soc Nephrol. 2002. 13; 142 – 148.
9. Tang S., Leung J.C., Chan L.Y. et al. Mycophenolate mofetil alleviates persistent proteinuria in IgA nephropathy. Kidney Int. 2005. 68; 802 – 812.
10. Tumlin J.A., Hennigar R.A.. Clinical presentation, natural history, and treatment of crescentic proliferative IgA nephropathy. Semin Nephrol. 2004. 24; 256 – 268.
11. Haas M., Jafri J., Bartosh S.M. et al. ANCA-associated crescentic glomerulonephritis with mesangial IgA deposits. Am J Kidney Dis. 2000. 36; 709 – 718.
12. Samuels J.A., Strippoli G.F., Craig J.C. et al. Immunosuppressive treatments for immunoglobulin A nephropathy: a meta-analysis of randomized controlled trials. Nephrology (Carlton). 2004. 9; 177 – 185.
13. Hogg R.J., Wyatt R.J. A randomized controlled trial of mycophenolate mofetil in patients with IgA nephropathy (ISRCTN6257616). BMC Nephrol. 2004. 5; 3.
14. Jafar T.H., Stark P.C., Schmid C.H. et al. Progression of chronic kidney disease: The role of blood pressure control, 139; 244 – 252.
15. Kanno Y., Okada H., Saruta T. et al. Blood pressure reduction associated with preservation of renal function in hypertensive patients with IgA nephropathy: a 3-year follow-up. Clin Nephrol. 2000. 54; 360 – 365.
16. Praga M., Gutierrez E., Gonzalez E. et al. Treatment of IgA nephropathy with ACE inhibitors: a randomized and controlled trial. J Am Soc Nephrol. 2003. 14; 1578 – 1583.
17. Nakao N., Yoshimura A., Morita H. et al. Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial. Lancet. 2003. 361; 117 – 124.
18. Strippoli G.F., Manno C., Schena F.P. An ‘evidence-based’ survey of therapeutic options for IgA nephropathy: assessment and criticism. Am J Kidney Dis. 2003. 41; 1129 – 1139.
19. Hogg R.J., Lee J., Narelli N. et al. Multicenter placebo-controlled trial of alternate day prednisolone or daily omega-3 fatty acids in children and young adults with IgA nephropathy. Report from the Southwest Pediatric Nephrology Study Group. J Am Soc Nephrol. 2003. 14; 751A.
20. Hotta O., Miyazaki M., Furuta T. et al. Tonsillectomy and steroid pulse therapy significantly impact on clinical remission in patients with IgA nephropathy. Am J Kidney Dis. 2001. 38; 736 – 743.
21. Xie Y., Nishi S., Ueno M. et al. The efficacy of tonsillectomy on long-term renal survival in patients with IgA ne¬phropathy. Kidney Int. 2003. 63; 1861 – 1867.
22. Rasche F.M., Schwarz A., Keller F. Tonsillectomy does not prevent a progressive course in IgA nephropathy. Clin Nephrol. 1999. 51; 147 – 152.
Электронный вариант:
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IgA-нефропатия (IgА-НП) является самой частой гломерулопатией во всех странах, лечение которой до сих пор остается спорным, в частности, в отношении применения иммуносупрессивных препаратов.Представлен опыт лечения 15 детей с IgA-НП в возрасте 7-18 лет. IgA-НП клинически проявлялась быстропрогрессирующим ГН у 1, сочетанием нефритического (НиС) и нефротического (НС) синдромов у 2, НиС у 4, НС у 2, сочетанием протеинурии (ПУ) и гематурии (ГУ) у 6. Скорость клубочковой фильтрации (СКФ) и ПУ в дебюте заболевания составили в среднем 74 мл/мин и 2.5 г/с соответственно. Морфологически (классификация Haas) 3 класс установлен у 6, 4 класс у 6 и 5 класс у 3 детей. На фоне последовательного лечения иммуносупрессорами общего и селективного действия у всех пациентов отмечено купирование экстраренальных проявлений, снижение протеинурии и улучшение фильтрационной функции почек, что наблюдалось так же и при монотерапии иАПФ.Таким образом, иммуносупрессивная терапия в сочетании с иАПФ эффективна при IgA-нефропатии и позволяет улучшить течение и прогноз заболевания.
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