Cited 0 times in Scipus Cited Count

Clinicopathologic Changes in Children with Immunoglobulin A Nephritis and Henoch-Schnlein Purpura Nephritis after Cyclosporine A and Angiotensin-converting Enzyme Inhibitor Treatment

Other Title
Immunuglobulin A 신질환과 Henoch-Schnlein purpura 신질환을 가진 소아에서의 cyclosporine A와 angiotensin-converting enzyme inhibitor 치료의 임상적, 병리학적 변화
Authors
이, 정주 | 김, 용진 | 신, 재일 | 임, 현이  | 박, 세진
Citation
Journal of the Korean Society of Pediatric Nephrology, 17(2). : 92-100, 2013
Journal Title
Journal of the Korean Society of Pediatric Nephrology
ISSN
1226-52922234-4209
Abstract
목 적: IgA 신병증, HSP 신병증은 사구체의 메산지움에 IgA가 침착되는 대표적인 질환이다. 본 연구는 소아에서, 이 두 가지 질환에 대한 Cyclosporin A 의 임상적 및 병리학적 효과를 평가하기 위하여 시행되었다.



방 법: 총 54명의 환자(IgA 신병증: Henoch-SchOnlein purpura 신병증=36:18)를 대상으로 후향적으로 연구를 진행하였다. CsA는 5mg/kg/day 으로 투여하였으며, 투여 전, 후로 단백뇨의 양을 측정, 병리학적 변화를 조사하기 위해 신생검을 시행하였다. HSP 신병증 및 IgA 신병증의 신생검은 병리학적으로 각각 ISKDC 분류법, Oxford 분류체계(2009)로 구분하였다.



결 과: 혈청 단백/크레아티닌 비는 치료 전후로 3.7±1.5에서 0.6±0.4으로 호전되었고(P<0.001), 총 54명 중 32명의 환자(59.2%)에서 CsA 치료 1년 후 단백뇨의 관해를 보였다. 신생검의 병리학적 소견은 호전되거나, 또는 치료 전후로 유지되는 양상을 보였으며, CsA로 인한 합병증은 없었다.



결 론: CsA 는 IgA의 사구체 침착을 특징으로 하는 IgA 신병증, HSP 신병증 환자에서 단백뇨 감소효과 및 말기신부전으로의 진행을 예방하는 데에 효과적인 것으로 사료된다.

Purpose: To investigate the clinicopathologic effects of cyclosporine A (CsA) in children with diseases characterized by mesangial immunoglobulin A deposits such as immunoglobulin A nephropathy (IgAN) and Henoch-SchOnlein purpura nephritis (HSPN).



Methods: We retrospectively reviewed the clinicopathologic outcomes of 54 children (IgAN, 36; HSPN, 18) treated with CsA. The starting dose of CsA was 5 mg/kg per day, and it was administered in 2 divided doses. The degree of proteinuria and pathologic changes in renal biopsies were evaluated before and after CsA treatment.



Results: The mean protein to creatinine ratio decreased from 3.7±1.5 to 0.6±0.4 (P <0.001), and 32 (59.2%) children achieved complete remission of proteinuria after 1-year CsA treatment. Among the 54 children, 24 maintained normal renal function and 25 exhibited microscopic hematuria or proteinuria at the end of CsA treatment. In the HSPN group, 3 children whose initial biopsies indicated class IIIb disease showed class II disease on follow-up, and the follow-up biopsies of 2 children who had class II disease indicated the same class II disease. In the IgAN group, cortical tubular atrophy occurred in 1 child, and no child with IgAN had cortical interstitial fibrosis or tubular atrophy after 1-year CsA treatment. No significant complications were found in the children treated with CsA.



Conclusion: Our findings indicate that CsA treatment is effective and beneficial in reducing massive proteinuria and preventing progression to end-stage renal failure in children with glomerular diseases characterized by IgA deposits, such as IgAN and HSPN, within 1 year of treatment.
Keywords
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Pathology
Journal Papers > School of Medicine / Graduate School of Medicine > Pediatrics & Adolescent Medicine
Ajou Authors
박, 세진  |  임, 현이
Full Text Link
Files in This Item:
There are no files associated with this item.
Export

qrcode

해당 아이템을 이메일로 공유하기 원하시면 인증을 거치시기 바랍니다.

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse