abdelreheam, G., Ahmed, A., Ali, S., Ahmed, N. (2017). Changes in Steroid Response pattern in Childhood Idiopathic Nephrotic Syndrome in Sohag. test, 21(1), 145-151. doi: 10.21608/smj.2017.40092
Ghada abdelreheam; Ali Ahmed; Safaa Ali; Naglaa Ahmed. "Changes in Steroid Response pattern in Childhood Idiopathic Nephrotic Syndrome in Sohag". test, 21, 1, 2017, 145-151. doi: 10.21608/smj.2017.40092
abdelreheam, G., Ahmed, A., Ali, S., Ahmed, N. (2017). 'Changes in Steroid Response pattern in Childhood Idiopathic Nephrotic Syndrome in Sohag', test, 21(1), pp. 145-151. doi: 10.21608/smj.2017.40092
abdelreheam, G., Ahmed, A., Ali, S., Ahmed, N. Changes in Steroid Response pattern in Childhood Idiopathic Nephrotic Syndrome in Sohag. test, 2017; 21(1): 145-151. doi: 10.21608/smj.2017.40092

Changes in Steroid Response pattern in Childhood Idiopathic Nephrotic Syndrome in Sohag

Sohag Medical Journal
Article 13, Volume 21, Issue 1, January 2017, Pages 145-151    PDF (84.31 K)
Document Type: Original Article
DOI: 10.21608/smj.2017.40092
Authors
Ghada abdelreheam; Ali Ahmed; Safaa Ali; Naglaa Ahmed
Department of Pediatrics Faculty of Medicine, University of Sohag
Abstract
Background and aim of work: Nephrotic syndrome (NS) is a common chronic kidney disease in childhood and it is mostly idiopathic. Steroid response pattern remains the most important issue in prognosis of NS. Increase in steroid resistant nephrotic syndrome (SRNS) frequency over years was documented in some studies. This work aimed to demonstrate the change in steroid response pattern of idiopathic nephrotic syndrome (INS) over years in our locality at Sohag in Upper Egypt.
Patients and Methods: Combined retrospective and prospective studies were done; including 280 children with INS, aged from 1 to 15 years, diagnosed and followed in our pediatric renal unit in Sohag University Hospital, Egypt in the period from January 2000 to December 2014. The patients' demographic features, steroid response pattern in both groups were studied.
Results: A total of 280 patients (203 in the retrospective group and 77 in the prospective group) with INS were included with mean age at disease onset 4.60±2.58 (range 1-15) years and male/female ratio 1.8/1. Mean follow up duration was 4.44±3.24 (range 1-15) years. Steroid was given to all patients. 94.1% and 79.2% of patients in the retrospective and the prospective groups respectively were steroid sensitive, and the rest of patients were steroid resistant. Renal biopsy was done in 36 and 26 patients in the retrospective and prospective studies respectively. Biopsy results revealed minimal change disease (MCD) in 55.6% and 38.5%, focal segmental glomerulosclerosis (FSGS) in 22.2% and 42.3%, mesangioproliferative glomerulonephritis (MesPGN) in 22.2% and 19.2% of biopsied patients in the retrospective and prospective groups respectively. End stage renal disease (ESRD) was developed in 4 patients all of them were steroid and other immunosuppressive therapies resistant and with FSGS histopathology. Death occurred in 5 patients.
Conclusion: Steroid sensitive NS is the most common form of INS in children but there is increase in the frequency of SRNS over years in our locality.
Keywords
Idiopathic nephrotic syndrome; steroid resistant; focal segmental glomerulosclerosis
Supplementary Files
References
  1. Arif MK, Arif M, Amjad N (2016) A histopathological outlook on nephrotic syndrome: A pediatric perspective. Indian J Nephrol 26(3):188–191
  2. Bagga A (2008) Revised guidelines for management of steroid-sensitive nephrotic syndrome. Indian J Nephrol 18(1):31–39
  3. Bakr A, Eid R, Sarhan A, Hammad A, El-Refaey AM, et al (2014) Pathological profile of biopsied Egyptian children with primary nephrotic syndrome: 15-year single center experience J Nephrol 27(4):419-423
  4. Banaszak B and Banaszak P (2012) The increasing incidence of initial steroid resistance in childhood nephrotic syndrome. Pediatr Nephrol 27:927–932
  5. Chanchlani R, Parekh RS (2016) Ethnic Differences in Childhood Nephrotic Syndrome. Frontiers in Pediatrics 4:39
  6. Felix MB, Parra C, Dajani T, Ferris M, Rita D, Swinford RD, et al (1999) Changing patterns in the histopathology of idiopathic nephrotic syndrome in children. Kidney International 55:1885–1890
  7. Filler G, Young E, Geier P, Carpenter B, Drukker A, Feber J (2003) Is there really an increase in non-minimal change nephrotic syndrome in children? Am J Kidney Dis42:1107–1113
  8. Gipson DS, Massengill SF, Yao L, Nagaraj S, Smoyer WE, Mahan JD, et al (2009) Management of childhood onset nephrotic syndrome. Pediatrics 124(2):747–757
  9. Gulati S, Sharma AP, Sharma, Gupta A (1999) Changing Trends of Histopathology in Childhood Nephrotic Syndrome. American Journal of Kidney Diseases 34(4):646-650
  10. Hacıhamdioğlu DÖ, Kalman S, Gök F (2015) Long-term results of children diagnosed with idiopathic nephrotic syndrome; single center experience. Türk Ped Arş 50:37-44
  11. Kaddah A, Sabry S, Emil E, El-Refaey M (2012) Epidemiology of primary nephrotic syndrome in Egyptian children. J Nephrol25 (05):732-737
  12. Kaneko K, Tsuji S, Kimata T, et al (2015) Pathogenesis of childhood idiopathic nephrotic syndrome: a paradigm shift from T-cells to podocytes. World J Pediatr 11:21-28
  13. Kari JA (2002) Changing trends of histopathology in childhood nephrotic syndrome in western Saudia Arabia. Saudia Med J 23:317–321
  14. KDIGO (Kidney Disease Improving Global Outcomes) Glomerulonephritis Work Group 2012: KDIGO clinical practice guideline for glomerulonephritis. Kidney Int Suppl 2:139-274
  15. Kim JS, Bellew CA, Silverstein DM, Aviles DH, Boineau FG, Vehaskari VM (2005) High incidence of initial and late steroid resistance in childhood nephrotic syndrome. Kidney Int 68:1275-1281
  16. Madani A, Fahimi D ,Taghaodi R, Mahjoob F, Hajizadeh N, Navabi1 B (2010) An Estimation of Steroid Responsiveness of Idiopathic Nephrotic Syndrome in Iranian Children. Iranian Journal of Pediatrics 20:199-205
  17. Niaudet P, Boyer O: Idiopathic nephrotic syndrome in childhood: clinical aspects. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N editors: Pediatric Nephrology. 6th ed. Germany: Springer-Verlag, 2009; 667-702.
  18. Niaudet P, Boyer O: Idiopathic nephrotic syndrome in childhood: clinical aspects. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N, Emma F, Goldstein SL editors: Pediatric Nephrology, 6th edition, Heidelberg, Germany, Springer-Verlag, 2016; 839-882.
  19. Nickavar A, Harahdashti AL (2014) Trends in Steroid Response Among Children With Idiopathic Nephrotic Syndrome. Iranian Journal of Kidney Diseases 8(5):389-393
  20. Pais P, Avner ED: Nephrotic syndrome. In: Kliegman RM, Stanton BF, Geme JW, Schor NF editors: Nelson Textbook of pediatrics, 20th ed, Philadelphia, Elsevier Inc, 2016; 527:2521-2527.
  21. Pais, Ellis, Avner ED: Nephrotic syndrome. In: Kliegman RM, Stanton BF, Geme JW, Schor NF, Behrman RE, editors: Nelson Textbook of pediatrics 19th ed, Philadelphia, Elsevier Saunders, 2011; 521:1801-1807.
  22. Seif EI, Eman Ibrahim AS, Elhefnawy NG, Salman MI (2013) Histological patterns of idiopathic steroid resistant nephrotic syndrome in Egyptian children: A single centre study. J Nephropathology 2(1):53-60
  23. Srivastava T, Simon SD, Alon US (1999) High incidence of focal segmental glomerulosclerosis in nephrotic syndrome of childhood. Pediatr Nephrol 13:13–18
  24. Valentini RP, Smoyer WE: Nephrotic syndrome. In: Kher KK, Schnaper HW, Makker SP, editors: Clinical Pediatric Nephrology. Second edition, Informa Healthcare, 2007; 11:155-194.
  25. Wong W (2007) Idiopathic nephrotic syndrome in New Zealand children, demographic, clinical features, initial management and outcome after twelve-month follow-up: Results of a three-year national surveillance study. Journal of Paediatrics and Child Health 43:337–341
  26. Zaki M, Helin I, Manandhar DS, Hunt MCJ, Khalil AF (1989) Primary nephrotic syndrome in Arab children in Kuwait. Pediatr Nephrol 3(2):218-221
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