MPO-ANCA型一次性急速進行性糸球体腎炎における腎機能予後と血清クレアチニン上昇速度の関係

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  • MPO ANCAガタ 1ジセイ キュウソク シンコウセイ シキュウタイジンエン ニ オケル ジンキノウ ヨゴ ト ケッセイ クレアチニン ジョウショウ ソクド ノ カンケイ
  • Daily Increase of Serum Creatinine Levels is Involved in Renal Outcome in Primary MPO-ANCA Positive Rapidly Progressive Glomerulonephritis

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To determine a clinical marker associated with renal outcome in patients with myeloperoxidaseantineutrophil cytoplasmic antibody (MPO-ANCA)-positive primary rapidly progressive glomerulonephritis (RPGN), clinical data were retrospectively reviewed. We studied ten patients who had been treated at the Department of Nephrology, Tokyo Metropolitan Komagome Hospital, between January 1999 and August 2004. All the patients were generally treated with oral steroids (predonisolone, 0.8 mg/kgBW, daily). Three patients received maintenance hemodialysis (HD) treatment but the remaining 7 patients did not. The former patients were designated as the HD group, and the latter patients were designated as the non-HD group. The change in the serum creatinine (Cr) value was calculated each day in every patient. The daily serum Cr increase in the HD groupwas 0.64 ± 0.26 mg/dl, which was significantly higher than that in the non-HD group (0.05 ± 0.07 mg/dl; p< 0.01). Consequently, the serum Cr levels at the initiation of OS treatment and the maximum levels of serum Cr during the patients' clinical courses were significantly higher in the HD group (9.1 ± 2.2 mg/dl and 10.1 ± 1.9 mg/dl, respectively; p<0.0l) than in the non-HD group (3.5 ± 1.4 mg/dl and 3.9 ± 1.6 mg/dl, respectively; p<0.0l). In addition, the "clinical scores for disease severity", which was comprehensively developed to assess the prognosis of RPGN patients, was significantly higher in the HD group (7.0 ± 0.0 versus 4.0 ± 5.1; p<0.01). In conclusion, this study suggests that a high daily increase in serum Cr (over 0.6 mg/dl) may reflect poor renal survival in MPO-ANCA-positive primary RPGN patients. The daily increase in serum Cr levels may effectively reflect the dynamism of renal function in MPO-ANCA-positive primary RPGN patients and may be useful for assessing the efficacy of treatment.

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