Korean Journal of Nephrology 1994;13(3):519-526.

소아 미세변화 신증후군의 스테로이드 치료에서의 SPI, 혈청 IgE및 알부민치의 임상적 의의

김미경 , 권민중 , 김병길

Abstract

Minimal change nephrotic syndrome (MCNS) com- prises the majority of nephrotic syndrome in children and is generally known to show good response to corticosteroid therapy. In the past, selective protein index (SPI) was widely used as a predictive index for the therapeutic response of MCNS to corticosteroid. But SPI in clinical use happened to fail such a role in many cases. There are many reports that serum IgE level is associated with the prognosis of MCNS. And also, there is a report that serum albumin level is associated with the response of MCNS to corticosteroid. So we evaluated the significance of SPI, serum IgE and serum albumin level taken together at the same time in therapeutic response to corticosteroid in childhood MCNS. One hundred six biopsy proven MCNS patients reviewed. No direct relationship was found between SPI and the time required to achieve remission after initiation of corticosteroid therapy. And also, there was no direct relationship between serum albumin level and the time required to achieve remission. But, there was a direct relationship between serum IgE level and the time required to achieve remission. There was a relatively significant difference in serum IgE level between steroid response group within 2 weeks and steroid response group after 2 weeks, steroid response group within 2 weeks had an evidently higher level of IgE. Although SPI was not different at all between steroid response group within 2 weeks and after 2 weeks, the group with SPI less than 0,1 had a tendency to show an early response. Therefore serum IgE level is more sensitive as well as specific than SPI for the prediction of prognosis, while serum albumin level has no relation to the prognosis. But the etiology and pathogenesis of MCNS is uncertain, and there is some difficulty in observing the changes of serum IgE in all the patients. So we suggest that both serum IgE level and SPI should be used as a predictive indices for the therapeutic response of corticosteroid in MCNS patients. Also, serum IgE level should be observed periodically in order to monitor any signs of recurrences and variations of treatments.