nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2021-25-4-48-56nefr-2009Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ. КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯORIGINAL ARTICLES. CLINICAL INVESTIGATIONSФакторы риска прогрессирования IgA-нефропатии у детейRisk factors for progression IgA-nephropathy in childrenhttps://orcid.org/0000-0002-1517-0251ПроскураМ. В.ProskuraM. V.

Проскура Мария Владимировна, кафедра госпитальной педиатрии им. академика В.А. Таболина ПФ, аспирант

119571, Россия, Москва, Ленинский пр., д. 117

 Тел.: (+7) 495 936-91-30

Mariia V. Proskura, Department of Hospital Pediatrics named after academician V.A. Tabolin PF, postgraduate.

119571, Russia, Moscow, Leninsky Prospect, 117

 Phone: (+7) 495 936-91-30

md.proskura@gmail.comhttps://orcid.org/0000-0002-5160-4512ПетросянЭ. К.PetrosyanE. K.

Проф. Петросян Эдита Константиновна, д-р мед. наук, кафедра госпитальной педиатрии им. академика В.А. Таболина ПФ. 

119571, Россия, Москва, Ленинский пр., д. 117

Тел.: (+7) 495 936-91-30

Prof. Edita K. Petrosyan , Department of Hospital Pediatrics named after academician V.A. Tabolin PF, professor. 

119571, Russia, Moscow, Leninsky Prospect, 117

Phone: (+7) 495 936-91-30

ed3565@yandex.ruhttps://orcid.org/0000-0002-0934-0349ПовилайтитеП. Э.PovilaititeP. E.

Повилайтите Патриция Эдмундовна, канд. биол. наук, врач клинической лабораторной диагностики высшей категории, зав. отд. высокотехнологичных методов диагностики ГБУ РО «ПАБ»

344015, Россия, г. Ростов-на-Дону, ул. Благодатная, д. 170а.

Тел.: (+7) 918 554-98-35

Patrisia E. Povilaitite, doctor of clinical and laboratory diagnostics, State Institution of Health

344015, Rostov-on-Don, Russian Federation, Blagodatnaya str., 170a

Phone: (+7) 918 554-98-35

povpe@yandex.ruhttps://orcid.org/0000-0002-0511-8222КушнирБ. Л.KushnirB. L.

Кушнир Берта Леонидовна, врач-патологоанатом

119571, Россия, Москва, Ленинский пр., д. 117/2

Тел.: (+7) 910 401-60-63

Berta L. Kushnir, pathologist

119571, Russia, Moscow, Leninsky Prospect, 117, build 2

Phone: (+7) 910 401-60-63

kushnir.berta@gmail.comРоссийская детская клиническая больница РНИМУ им. Н.И.ПироговаРоссияRussian Children's Clinical Hospital, Pirogov Russian National Research Medical UniversityRussian FederationРоссийская детская клиническая больница РНИМУ им.Н.И.ПироговаРоссияRussian Children's Clinical Hospital, Pirogov Russian National Research Medical UniversityRussian FederationПатологоанатомическое бюро Ростовской областиРоссияRostov Region "Pataloanatomical Bureau"Russian FederationРоссийская детская клиническая больница РНИМУ им.Н.И. ПироговаРоссияRussian Children's Clinical Hospital, Pirogov Russian National Research Medical UniversityRussian Federation2021150720212544856Copyright © Проскура М.В., Петросян Э.К., Повилайтите П.Э., Кушнир Б.Л., 20212021Проскура М.В., Петросян Э.К., Повилайтите П.Э., Кушнир Б.Л.Proskura M.V., Petrosyan E.K., Povilaitite P.E., Kushnir B.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/2009ВВЕДЕНИЕ

ВВЕДЕНИЕ. Течение, исходы первичной IgA-нефропатии у детей вариабельны. Назначение своевременной терапии лицам с высоким риском позволит отсрочить развитие терминальной почечной недостаточности.

ЦЕЛЬ

ЦЕЛЬ: анализ факторов риска прогрессирования и исходов у детей с IgA-нефропатией с учетом клинико-морфологических данных в дебюте и при динамическом наблюдении.

ПАЦИЕНТЫ И МЕТОДЫ

ПАЦИЕНТЫ И МЕТОДЫ. Ретроспективно исследовано 75 детей, медиана наблюдения составила 28 мес. Медиана возраста дебюта составила 9,1 года. Пациенты разделены на 2 группы: 1-я – больные с идиопатической IgA-нефропатией (n=53), 2-я – больные с пурпурой Шенлейна–Геноха (n=22). Всем пациентам морфологически подтвержден диагноз первичной IgA-нефропатии. Данные нефробиопсии классифицированы по Оксфордской шкале (MEST-C). Анализировались возраст дебюта и первичной госпитализации, уровень протеинурии и скорости клубочковой фильтрации (СКФ) в дебюте, через 12 мес, по окончании наблюдения, среднее артериальное давление, баллы MEST-C шкалы, лекарственная терапия перед нефробиопсией. Прогрессирование оценивалось по снижению СКФ менее 60 мл/мин/1,73 м2. Исходы оценены по отсутствию/наличию ремиссии. Проводился поиск факторов, влияющих на СКФ в конце наблюдения. Анализ данных выполнялся с применением t-критерия Стьюдента, Манна–Уитни, χ2, Фишера, линейной регрессионной модели, бинарной логистической регрессии.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. В отличие от взрослых прогностическая ценность MEST-C шкалы у детей не доказана, не сопряжена со снижением СКФ <60 мл/мин/1,73 м2. СКФ по окончании наблюдения в группе идиопатической IgA-нефропатии была ниже, чем во 2-й группе. Использование множественной линейной регрессии позволяет предсказывать СКФ в среднем через 28 мес наблюдения.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Влияние морфологических факторов на исход и течение IgA-нефропатии не доказано. Уровень СКФ в дебюте, среднее АД и возраст первичного обращения оказались независимыми переменными, позволяющими выделить детей с ожидаемым снижением СКФ менее 90 мл/мин/1,73 м2 в группу особого диспансерного наблюдения.

BACKGROUND

BACKGROUND. The course and outcomes of primary IgA nephropathy in children are variable. Early therapy for high-risk individuals can help to delay the development of end-stage renal disease.

THE AIM

THE AIM: to analysis of risk factors for progression and outcomes in children with IgA nephropathy, taking into account clinical and morphological data at the onset and during follow-up.

PATIENTS AND METHODS

PATIENTS AND METHODS. A retrospective study of 75 children was carried out; the median follow-up was 28 months. The median age of onset was 9.1 years. Patients were divided into 2 groups: 1st – patients with idiopathic IgA nephropathy (n= 53), 2nd – patients with Shenlein-Henoch purpura (n = 22). The diagnosis of primary IgA nephropathy was morphologically confirmed in all patients. Nephrobiopsy data were classified according to the Oxford scale (MEST-C score). The age of onset and first-time admission, the level of proteinuria and glomerular filtration rate (GFR) at the onset, at 12 months, at the end of follow-up, mean arterial blood pressure, MEST-C score, medication before nephrobiopsy were investigated. Progression was determined as a decrease in GFR less than 60 ml/min/1.73 m2. Outcomes were assessed by absence/presence of remission. We provided a search for factors influencing GFR at the end of the follow-up. Data analysis was performed using Student's t-test, Mann-Whitney, χ2, Fisher, linear regression model, binary logistic regression.

RESULTS

RESULTS. Unlike adults, the predictive value of the MEST-C score in children has not been proven and is not associated with a decrease in GFR <60 ml/min/1.73 m2. GFR at the end of follow-up was lower in the idiopathic IgA nephropathy group than in group 2. The use of multiple linear regression predicts GFR on average after 28 months of observation.

RESULTS

RESULTS. Unlike adults, the predictive value of the MEST-C scale in children has not been proven and is not associated with a decrease in GFR <60 ml/min/1.73 m2. GFR at the end of follow-up was lower in the idiopathic IgA nephropathy group. The use of multiple linear regression predicts GFR on average after 28 months of observation.

CONCLUSIONS

CONCLUSIONS. The influence of morphological factors on the outcome and course of IgA nephropathy has not been proven. The level of GFR at the onset, mean blood pressure, and the age of the first-time admission turned out to be independent variables, which made it possible to identify children with an expected decrease in GFR less than 90 ml/min /1.73 m2 to the group of specific outpatient follow-up.

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The authors declare that there are no conflicts of interest present.