Clinical characteristics and therapeutic response of primary nephrotic syndrome in adults
Authors
주현영
Issue Date
1988
Description
의학과/석사
Abstract
[한글]
원발성 신증후군은 이차적 원인 및 전신질환을 제외한 신 사구체병변으로 심한 단백뇨, 저알부민혈증, 전신부종 및 고지혈증 등의 임상양상율 보이는 증후군으로 신생검을 통한 조직병리 소견에 따라 미세변화형 (minimal change), 막성신증 (membranous nephropathy), 맥증식성 사구체신염 (mesangio-proliferative GN), 국소분절성 사구체경화증 (focal segmental glomerulosclerosis), 막증식성 사구체신염 (membranoproliferative GN) 등으로 분류된다. 그러나 각 원인질환에 따른 임상상, 치료반응및 경과에 대해서는 많은 논란이 되고 있다.
이에 저자는 1979년 1월부터 1987년 12월까지 5년동안 연세대학교 외과대학 세브란스병원 내과에 입원하여 원발성 신증후군으로 진단받고 경피 신생검으로 원인질환이 확진된 188 예를 대상으로 그 임상상, 치료에 대한 반응및 경과를 분석하여 다음과 같은 결과를
membranoproliferative GN(5.3%) and focal segmental glomerulosclerosis(2.7%).
2. Sex ratio was 2.5 to 1 with male preponderance. Mean age was 32.1
3. Incidence rate of hypertension was significantly higher in the group of
membranous nephropathy(48.4%) and membranoproliferative GN(70%) than that of
minimal change(16.8%). Microscopic he-maturia was noticed above 60% in all groups
and selective proteinuria in 50.8% of minimal change.
Positive rate of HBsAg was significantly higher in the group of membranous
nephropathy(45.2%) than that of minimal change(12.1%)1.
Decrease of Ig G level was observed in all groups.
4. With initial treatment, complete remission was obtained in 78.8% of minimal
change, 71.4% of mesangialproliferative GN. and 4.7% of membranous nephropathy. No
response were noticed in 55.5% of membranoproliferative GN, 65.7% of membranous
nephropathy and all of focal segmental glomerulosclerosis.
5. During the follow-up period (mean 22-months), course of minimal change was
relatively good with 69.5% in complete remission state, partial remission state in
10.7%, relapsed nephrotic syndrome in 18.41%.
6. The main complications observed were infection, thromboembolism and acute
renal failure and were seen in 23.4% of the cases.
[영문]
Primary nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, generalized edema and hyperlipidemia, and caused by primary glomerular damage excluding of secondary known causes. It is classified according
to the histopathologic features found on renal biopsy into minimal change, mesangi O-proliferative glomerulonephritis, focal segmental glomerulosclerosis, membranous nephropathy and membranoproliferative glomerulonephritis. However, the clinical
characteristics and the response to treatment of each disease are variable.
To ascertain useful clinicopathological correlationship of each disease entities and to understand long-term clinical courses, studies on clinicopathologic observations as well as responses to treatment and follow-up status were evaluated on 188 cases of primary nephrotic syndrome who were admitted to the Severance
Hospital, Yonsei University Medical Center during past 9 years from January 1979 to December 1987 and following results were obtained.
1. Pathologic findings of 188 patients were classified into minimal change(69.6%), membranous nephropathy (16.5%), mesangi 0-proliferative GN(5.9%), membranoproliferative GN(5.3%) and focal segmental glomerulosclerosis(2.7%).
2. Sex ratio was 2.5 to 1 with male preponderance. Mean age was 32.1
3. Incidence rate of hypertension was significantly higher in the group of membranous nephropathy(48.4%) and membranoproliferative GN(70%) than that of minimal change(16.8%). Microscopic he-maturia was noticed above 60% in all groups
and selective proteinuria in 50.8% of minimal change.
Positive rate of HBsAg was significantly higher in the group of membranous nephropathy(45.2%) than that of minimal change(12.1%)1.
Decrease of Ig G level was observed in all groups.
4. With initial treatment, complete remission was obtained in 78.8% of minimal change, 71.4% of mesangialproliferative GN. and 4.7% of membranous nephropathy. No response were noticed in 55.5% of membranoproliferative GN, 65.7% of membranous nephropathy and all of focal segmental glomerulosclerosis.
5. During the follow-up period (mean 22-months), course of minimal change was relatively good with 69.5% in complete remission state, partial remission state in 10.7%, relapsed nephrotic syndrome in 18.41%.
6. The main complications observed were infection, thromboembolism and acute renal failure and were seen in 23.4% of the cases.