Complications and renal biopsy profile in childhood steroid resistant nephrotic syndrome

Authors

  • Subramani Palaniyandi Department of Paediatrics, Tagore Medical College and Hospital, Chennai, Tamilnadu, India
  • Anitha Palaniyandi Department of Paediatrics, Sri Ramachandra Medical College and Hospital, Chennai, Tamilnadu, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20202158

Keywords:

Minimal change disease, Nephrotic syndrome, Renal biopsy, SRNS

Abstract

Background: Nephrotic syndrome is a notable chronic disease in children. The objective of this study was to study the complications and renal biopsy profile in childhood steroid resistant nephrotic syndrome.

Methods: Retrospective observation study done in Sri Ramachandra Medical College and Hospital, Department of Paediatrics, Chennai. Inclusion criteria was children aged 1-12 years diagnosed with steroid resistant nephrotic syndrome defined as absence of remission despite therapy with daily prednisolone at a dose of 2mg/kg/day for 4 weeks. Remission defined as urine albumin nil/trace in 3 consecutive early morning samples. Children less than 1 year of age, children with renal transplant and incomplete records were excluded. Period of study January 2013- December 2015. Informed consent was obtained and 75 cases who fulfilled the study criteria were included in this study. Variables assessed were incidence of hypertension (both at onset of disease and later during the course of disease), incidence of urinary tract infection and its microbiology, associated co-morbidities, complications of nephrotic syndrome and renal biopsy profile.

Results: Incidence of hypertension at onset of disease was 13.3% and later during the course of the disease was 48%. Most common infection was UTI (28%) and the most common organism isolated in urine culture was E-coli. Incidence of other co-morbidities like asthma, atopy was 17.3%. No case had evidence of end stage renal disease. 60% of cases had undergone renal biopsy and minimal change disease was the most common biopsy finding.

Conclusions: Hypertension and UTI remain important complications in nephrotic syndrome and hence all such children should be continued to be monitored for these complications. Minimal change disease (MCD) was the most common renal biopsy finding.

References

Priya Pais, Ellis D. Avner. Nephrotic Syndrome. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier; 2016:2521.

Ali U, Bagga A, Banerjee S, Kanitkar M, Phadke KD, Senguttuvan P, et al. Revised guidelines for management of steroid sensitive nephrotic syndrome. Indian Pediatr. 2008;45:203-14.

Syndrome N. Prediction of histopatology from clinical and laboratory characteristics at time the diagnosis. A report of International Study of Kidney Disease in Children. Kidney Int. 1978;13:159-65.

Resnick J, Schanberger JE. Varicella reactivation in nephrotic syndrome treated with cyclophosphamide and adrenal corticosteroids. J Pediatr. 1973;83:451.

Kamei K, Miyairi I, Ishikura K, Ogura M, Shoji K, Funaki T, et al. Prospective study of live attenuated vaccines for patients with nephrotic syndrome receiving immunosuppressive agents. J Pediatr. 2018 May 1;196:217-22.

Banerjee S, Dissanayake PV, Abeyagunawardena AS. Vaccinations in children on immunosuppressive medications for renal disease. Pediatr Nephrol. 2016;31:1437.

International Study of Kidney Disease in Children. Minimal Change Nephrotic Syndrome in Children: Deaths During the First 5 to 15 years’ Observation. Report of the International Study of Kidney Disease in Children. J Urol. 1984 Sep;132(3):624.

Alwadhi RK, Mathew JL, Rath B. Clinical profile of children with nephrotic syndrome not on glucorticoid therapy, but presenting with infection. J Paediatr Child Health. 2004;40:28.

Gulati S, Kher V, Arora P, Gupta S, Kale S. Urinary tract infection in nephrotic syndrome. Pediatric Infect Dis J. 1996 Mar 1;15(3):237-40.

Ulinski T, Leroy S, Dubrel M, Danon S, Bensman A. High serological response to pneumococcal vaccine in nephrotic children at disease onset on high-dose prednisone. Pediatr Nephrol. 2008 Jul 1;23(7):1107.

Kerlin BA, Blatt NB, Fuh B, Zhao S, Lehman A, Blanchong C, et al. Epidemiology and risk factors for thromboembolic complications of childhood nephrotic syndrome: a Midwest Pediatric Nephrology Consortium (MWPNC) study. J Pediatr. 2009 Jul 1;155(1):105-10.

Lilova MI, Velkovski IG, Topalov IB. Thromboembolic complications in children with nephrotic syndrome in Bulgaria (1974-1996). Pediatr Nephrol. 2000;15:74.

Primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. A report of the International Study of Kidney Disease in Children. J Pediatr. 1981;98(4):561-4.

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Published

2020-05-22

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Original Research Articles