儿童类固醇依赖性肾病综合征1例

Ye.K. Lagodych, D. Ivanov, L. Vakulenko, O. Lytvynova
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摘要

肾病综合征(NS)是一种常见的肾小球病理遇到在儿科实践。主要临床表现为大量蛋白尿、低白蛋白血症、高脂血症和水肿。在所有NS病例中,75%的儿童有肾小球病变的组织学变异,表现为微小病变,对激素治疗敏感,但容易导致复发和类固醇依赖。这些儿童往往需要延长服用激素药物的时间或添加其他免疫抑制剂,这些药物可能具有明显的毒性。可用的免疫抑制剂治疗方案包括环磷酰胺、环孢素A、他克莫司和霉酚酸酯。使用利妥昔单抗是儿童类固醇依赖性肾病综合征的一种可能的替代治疗方法。然而,利妥昔单抗治疗儿童类固醇依赖性肾病综合征的有效性和安全性仍存在争议。目的是评估利妥昔单抗治疗儿童类固醇依赖性肾病综合征的疗效和安全性,以我们自己的临床案例为例。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical case of steroid-dependent nephrotic syndrome in a child
Nephrotic syndrome (NS) is a common glomerular pathology encountered in pediatric practice. The main clinical signs are massive proteinuria, hypoalbuminemia, hyperlipidemia, and edema. Among all cases of NS, 75 % of children have a histological variant of glomerular lesions in the form of minimal change di­sease that is sensitive to hormone therapy, but easily leads to relapse and steroid dependence. These children often need to extend the time of taking hormonal drugs or add other immunosuppressants, which can have significant toxicity. Available immunosuppressant treatment options include cyclophosphamide, cyclosporine A, tacrolimus, and mycophenolate mofetil. The use of rituximab is a possible alternative treatment for steroid-dependent nephrotic syndrome in children. However, the efficacy and safety of ritu­ximab in the treatment of childhood steroid-dependent nephrotic syndrome is still controversial. The purpose was to evaluate the efficacy and safety of rituximab treatment in a child with steroid-dependent nephrotic syndrome on the example of a clinical case from our own practice.
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