儿童链球菌感染后急性肾小球肾炎:蛋白尿水平与肾脏预后之间的关系。

Randula Ranawaka, Kavinda Dayasiri, Udara Sandakelum, Dulani Nelson, Manoji Gamage
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引用次数: 0

摘要

背景:链球菌感染后急性肾小球肾炎(PSAGN)多为良性疾病。PSAGN的常见后遗症包括高血压及其并发症和急性肾损伤。严重的PSAGN与显著的长期发病率相关,组织学异常,如月牙状肾小球肾炎很少报道。在一些人群中,由于蛋白尿水平高,PSAGN也与晚发性慢性肾病有关。目的:评价PSAGN患儿蛋白尿水平与肾脏预后的关系。方法:在斯里兰卡科伦坡的Lady Ridgeway医院进行了为期15个月的前瞻性观察研究。PSAGN患儿根据临床和实验室标准入组。持续性蛋白尿≥2+持续2周,血清肌酐> 100 μmol/L需要肾活检,通过光镜和免疫荧光评估。在6 - 8周内补体3 (C3)恢复正常。从患者记录中收集临床特征、尿蛋白水平和肾功能数据,并使用社会科学统计软件包和R语言进行统计计算,分析潜在的关联。获得了Lady Ridgeway儿童医院伦理审查委员会的伦理批准(参考号:LRH/ERC/2021/60)。结果:共纳入44例患者。男性27例(61.4%),女性17例(38.6%)。其中37例(84%)为5岁以上。20例(45%)患者有皮肤败血症史,18例(41%)患者有咽喉感染史。在蛋白尿≥2+的患者中,53%的患者血清肌酐> 100µmol/L,而在蛋白尿< 2+的患者中,7%的患者血清肌酐> 100µmol/L。PSAGN患者高度蛋白尿与血清肌酐升高有显著相关性(χ 2 = 7.8, P = 0.005)。logistic回归模型的比值比为1.049(95%可信区间为1.003 ~ 1.098),呈正向,相关性有统计学意义(P = 0.037)。蛋白尿与高血压程度或估计肌酐清除率之间没有显著关联。10例患儿行肾活检。5例患儿表现为月牙征(少于50%),3例患儿表现为典型的弥漫性增生性肾小球肾炎。1例患儿出现严重急性肾小管坏死,1例患儿出现月牙状肾小球肾炎(月牙状肾小球肾炎50%)。免疫荧光研究显示免疫球蛋白G和C3沉积在所有活检标本中。结论:重度蛋白尿与PSAGN患儿血清肌酐升高(bb0 100 μmol/L)显著相关。持续蛋白尿≥2+且记录最高血肌酐bbb100 μmol/L的患儿,多数有不典型肾组织学表现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Post-streptococcal acute glomerulonephritis in children: Association between proteinuria levels and renal outcomes.

Background: Post-streptococcal acute glomerular nephritis (PSAGN) is mostly a benign condition. The usual sequelae of PSAGN include hypertension, its complications, and acute kidney injury. Severe PSAGN is associated with significant long-term morbidity, and histological abnormalities such as crescentic glomerulonephritis are infrequently reported. PSAGN has also been linked to late-onset chronic kidney disease in some populations due to high levels of proteinuria.

Aim: To evaluate the association between proteinuria levels and renal outcomes in children with PSAGN.

Methods: This prospective observational study was conducted at Lady Ridgeway Hospital (Colombo, Sri Lanka) over 15 months. Children with PSAGN were enrolled based on clinical and laboratory criteria. Persistent proteinuria ≥ 2+ for 2 weeks and serum creatinine > 100 μmol/L warranted renal biopsy, assessed via light microscopy and immunofluorescence. Normalization of complement 3 (C3) within 6 to 8 weeks was required for inclusion. Data on clinical features, urine protein levels, and renal function were collected from patient records, and potential associations were analysed using Statistical Package for the Social Sciences and R language for statistical computing. Ethical approval was obtained from the Ethical Review Committee, Lady Ridgeway Hospital for Children (Ref No: LRH/ERC/2021/60).

Results: Forty-four patients were recruited. There were 27 (61.4%) male patients and 17 (38.6%) female patients. Thirty-seven (84%) of them were above 5 years of age. Twenty (45%) patients had a history of skin sepsis, and eighteen (41%) had a history of throat infection. Among patients with proteinuria ≥ 2+, 53% had serum creatinine > 100 µmol/L, while among those with proteinuria < 2+, 7% had serum creatinine > 100 µmol/L. The association of high-degree proteinuria with elevated serum creatinine was significant (χ² = 7.8, P = 0.005) in PSAGN. The odds ratio of the logistic regression model was 1.049 (95% confidence interval: 1.003-1.098), indicating a positive direction with statistically significant association (P = 0.037). There was no significant association between proteinuria and the degree of hypertension or estimated creatinine clearance. Ten children underwent renal biopsy. Crescents (less than 50%) were demonstrated in five children, while three children had typical diffuse proliferative glomerulonephritis. One child had severe acute tubular necrosis, and another had crescentic glomerulonephritis (crescents > 50%). The immunofluorescence studies revealed deposition of immunoglobulin G and C3 in all biopsy specimens.

Conclusion: High-degree proteinuria was significantly associated with elevated serum creatinine (> 100 μmol/L) in children with PSAGN. The majority of children with persistent proteinuria ≥ 2+ for more than 2 weeks and the highest recorded serum creatinine > 100 μmol/L had atypical renal histological findings.

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