小儿难治性肾病36例治疗体会

目的：探讨不同病理类型难治性肾病(RNS)的治疗方法。方法：在纠正影响激素效应的各种因素后，分别采用激素冲击、延长激素用药时间、转换激素类型、联用或增用免疫抑制剂等处理措施。结果：36例中有23例(63．89％)存在有不同程度的合并症，可影响激素的治疗效应。微小病变性(MCNS)激素敏感率最高(85．7％)，系膜增殖性肾炎(MsPGN)70％患儿表现为耐药(SR)，加用免疫抑制剂近期有效率可提高到85％；临床类型小部分表现为激素依赖，大部分为激素耐药。局灶节段性肾小球硬化(FSGS)和膜增殖性肾炎(MPGN)激素无效。结论：感染、低蛋白血症等合并症是影响难治肾病激素效应的常见因素。这些因素纠正后可大大提高临床缓解率；肾脏病理诊断对指导治疗及判断预后具有重要意义。

Therapy experience with 36 cases of child refractory nephritic syndrome

Objective: The purpose of this study is to explore the therapy method of child refractory nephritic syndrome (CRNS) in different clinical pathology types. Methods: On the bases of correcting various kinds of factors influencing the steroid effect, such measures as steroid pulse therapy, prolonged time of using steroid, conversions of steroid types, or tadditional administration of immunosupressive agents are adopted to the patients who accord with diagosising standard of child refractory nephritic syndrome (CRNS). Results: Of the 36 case, 23 patiants have been complicated with others diseases, having side effects on the treatment, which accounts for 63.89% (23/36). Minimal changes (MCNS ) in the treatment with steroid is the most effective, up to 85.7%. The steroid resistent (SR) were found in 70% of the infants. With immunosuppressive agents added, the efficacy of the treatment could rise to 85%. A little number in treatment showed steroid depentent (SD), but the majority showed steroid resistent. Focal segmental glomerulosclerosis (FSGS) and Membranous proliferative glomerulonephritis (MPGN) failed to respond to any steroid, showing steroid resistent. Conclusion: Infections, hypoalbuminemia, and others diseases are common factors that have greatly affected steroid therapy on child refractory nephritic syndrome. The clinical remission rate of child refractory nephritic syndrome can be greatly improved after these factors are corrected. Renal pathological diagnosis is significant in guiding therapy and judging the prognosis.