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