Triggers, Duration of Therapy and Sedimentation Rate in Children with Nephrotic Syndrome

Research Article

Austin J Nephrol Hypertens. 2015;2(3): 1039.

Triggers, Duration of Therapy and Sedimentation Rate in Children with Nephrotic Syndrome

Kopac M*

Department of Nephrology, Division of Pediatrics University Medical Centre, Slovenia

*Corresponding author: Kopac M, Department of Nephrology, Division of Pediatrics, University Medical Centre Ljubljana Bohoriceva 20, 1000 Ljubljana Slovenia

Received: March 12, 2015; Accepted: April 28, 2015; Published: May 05, 2015

Abstract

Aim: Triggers, duration of daily corticosteroid therapy and the role of Erythrocyte Sedimentation Rate (ESR) in children with Idiopathic Steroid Sensitive-Nephrotic Syndrome (SSNS) were evaluated.

Methods: 40 episodes (9 initial episodes and 31 relapses) of idiopathic SSNS in 9 children were evaluated (2 had FSGS, 5 minimal change diseases). Data are presented as average +/- standard deviation. Different subgroups were compared with student’s t-test and equality of variance tested with F-test.

Results: All of the 9 initial episodes and only 58.1 % of relapses were triggered by acute, mostly afebrile respiratory tract infections. Duration of daily corticosteroid therapy was shorter in patients with Steroid-Dependent Nephrotic Syndrome (SDNS) compared to other patients (14.5 +/- 7.6 vs. 24.7 +/- 6.8 days, p=0.071) and shorter in small children with Body Surface Area (BSA) < 1 m2 compared to children with BSA > 1 m2 (14.8 +/- 9.8 vs. 26.7 +/- 18.9 days, p = 0.058) but the difference did not reach statistical significance. Average ESR was 71,6 +/- 30,5 mm/h in initial episodes compared to 20,5 +/- 23,8 mm/h in relapses (p = 0.000058). The correlation coefficient between time to achieve remission and ESR was 0.09.

Conclusion: Children with initial episodes of SSNS had higher proportion of triggers as well as higher ESR compared to relapses. There was no correlation between time to achieve remission with daily corticosteroid therapy and ESR or between histology result of renal biopsy and clinical course of SSNS.

Keywords: Triggers; Erythrocyte sedimentation rate; Steroid sensitivenephrotic syndrome; Initial episodes; Relapses

Introduction

Idiopathic nephrotic syndrome is the most common glomerular disease of childhood, representing approximately 90 % of children with nephrotic syndrome. It includes three histologic types: Minimal Change Disease (MCD), mesangial proliferation and Focal Segmental Glomerulosclerosis (FSGS). MCD is the most common among them, representing about 85 % of cases. The initial episode and subsequent relapses may follow minor infections and, sometimes, insect bites, bee stings or poison ivy [1]. Over 90 % of children with MCD respond to corticosteroid therapy and over 70 % among them subsequently develop a relapsing course. Response to corticosteroid therapy is the most important factor in determining prognosis since a good response to this therapy is ssociated with a low risk of developing chronic kidney disease [2]. The purpose of this retrospective study was to analyse the triggers (triggering events) of idiopathic nephrotic syndrome as well as duration of daily corticosteroid therapy needed to achieve remission. I analysed this in different subgroups of these patients, such as patients with Steroid Dependent Nephrotic Syndrome (SDNS), defined as having relapses whilst on steroid therapy or within 14 days of its discontinuation [2], and also in patients of different sizes. The role of Erythrocyte Sedimentation Rate (ESR) in Steroid Sensitive-Nephrotic Syndrome (SSNS) was also evaluated because following levels of ESR over time is useful in

Materials and Methods

40 episodes of idiopathic SSNS in 9 children between years 2009 and 2013 were evaluated. There were 9 initial episodes and 31 relapses among them. Table 1 presents clinical characteristics of patients included in the study. I analysed triggers, time to achieve remission with daily corticosteroid (1 mg/kg of methylprednisolone) therapy (in days) and Erythrocyte Sedimentation Rate (ESR, in mm/h) in all episodes of nephrotic syndrome as well as in different subgroups. The subgroups analysed and compared were patients with SDNS vs. others, initial episodes of nephrotic syndrome vs. relapses and small children with Body Surface Area (BSA) < 1 m2 vs. children with BSA > 1 m2. BSA in children was calculated according to Mosteller formula: BSA (m2) Height(cm)×Weight(kg) 3600 [email protected]@[email protected]@+=feaaguart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLnhiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq=Jc9vqaqpepm0xbba9pwe9Q8fs0=yqaqpepae9pg0FirpepeKkFr0xfr=xfr=xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaWaaOaaaeaadaWcaaqaaiaadIeacaWGLbGaamyAaiaadEgacaWGObGaamiDaiaacIcacaWGJbGaamyBaiaacMcacqGHxdaTcaWGxbGaamyzaiaadMgacaWGNbGaamiAaiaadshacaGGOaG[email protected][email protected] (4)