Childhood nephrotic syndrome, frequent and infrequent relapses and risk factors for relapses

Most patients with steroid sensitive nephrotic syndrome [SSNS] have frequent relapses until disease resolve spontaneously toward the end of second decade of life and so the main problem in such disease is frequent relapses and their association with complications of disease or side effects of drugs used in each relapse. In this study, we evaluate different factors which might be associating or leading to occurrence of frequent relapses. A retrospective study was done in the Central Child Teaching Hospital from Feb. 2007-Feb. 2008, during this period, 120 patients with nephrotic syndrome [NS] randomly selected who were diagnosed and or treated in this hospital. Out of 120 patients, 85 [70.8%] patients with steroid sensitive nephrotic syndrome [SSNS], 9 [7.5%] patients with steroid dependant nephrotic syndrome [SDNS] and 26 [2 1.7%] patients with steroid resistant nephrotic syndrome [SRNS]. The steroid sensitive patients were divided into 24 [28.2%] patients as undetermined [UD] group, 35 [41.2%] patients with frequent relapses [FR] group and 26 [30.5%] patients with infrequent relapses [IFR] group. We compare between frequent and infrequent groups regarding to age, sex, type of presentation, biochemical finding, precipitating factors, family history of renal disease, the time needed to responsd to steroid therapy and duration of steroid therapy. The age ranged from 1-16 years, with peak incidence at age group from 1-5 years. There were 64 patients [53.3%] presented with this age group, most of them were steroid sensitive nephrotic syndrome 53 [82.5%] patients. There were 73 male and 47 female and M: F ratio 1.5: 1, most of them [70.8%] with steroid sensitive nephrotic syndrome and male to female ratio was 1.8: 1. The main type of presentation was preiorbital oedema; the main type of precipitating factor was respiratory tract infection. The family history of renal disease [P value=0.0006] and the delay in response to steroid therapy, 2 weeks and more [P value=0.0477 and 0.0486] were statistically significant correlation with frequent relapsers [FR] group in comparison to infrequent [IFR] group. There were no statistically significant differences between frequent and infrequent groups regarding other factors. There were significant correlation between family history of renal disease and delay in response to steroid therapy with occurrence of frequent relapses supporting other studies but this study fails to confirm previous studies about other factors

Acute renal failure in children below 12 years causes, clinical presentation and management

Acute renal failure [ARF] is a common condition in hospitalized patients, characterized by a rapid fall in glomerular filtration rate [GFR], carries a high morbidity and mortality, often preventable, so rapid recognition and treatment may prevent irreversible loss of nephrons. To find out the cause of acute renal failure in children and to study the clinical presentation and management modalities and sequel. A prospective study done in Central Teaching Hospital for children from January 2006 to December 2006. 120 patients aged 1 month- to 12 years who were diagnosed and treated as cases of acute renal failure were collected and analyzed. And the distribution of patients according to [age, sex, type of presentation, laboratory finding, type of management and sequel] were done. From hundred twenty patients, there were 77 male and 43 female with 1.7:1 ratio distributed into 93 infant, 14 preschool and 13 school age group .The main type of presentation was acidosis, oliguria and dehydration. The main causes were gastroenteritis, sepsis and obstructed uropathy in infancy and preschool children, glomerular disease in school age group. 97 need conservative treatments and 23 need urgent peritoneal dialysis [PD] with mortality rate 5.15%, 30.51% respectively. Acute renal failure occurred more in infancy and most of them were prerenal acute renal failure can be handled with conservative treatment; peritoneal dialysis is a good choice for treatment of acute renal failure not resolved by conservative therapy

Clinical course of children and adolescents with primary focal segmental glomerulosclerosis and the predictors of their outcome

The aim of this retrospective study is to report the clinical course of children and adolescents with primary focal segmental glomerulosclerosis [FSGS], and to study their outcome and to identify the predictors of progression to end stage renal disease [ESRD]. This is a retrospective study of 50 patients with biopsy-proven primary FSGS who were admitted from April 1995 - January 2007, during the study period from May 2005 - June 2007. Clinical, Laboratory and histopathological data were recorded. The median follow-up time of 4.5 year. The commonest age and sex group is male between 1 - 5 year. At presentation all patients had nephrotic-range proteinuria, hypertension was noted in 22 [44%] of patients, microscopic haematuria was detected in 20 [40%] of patients, five patients had evidence of abnormal renal function. The distribution of patients according to steroid responsiveness show that the steroid sensitive patients were 21 [42%], 8 [38.09%] of them were frequent relapsers and 11 [52.38%] of them were steroid dependant and 2 [9.52%] of them developed secondary steroid resistance. But those who had steroid resistance from the start of treatment were 29 [58%] patients. During followup 30 [62%] patients had complete remission, 15 patients [30%] developed chronic kidney disease [9 of them stage 5].At the end of follow-up, 24 [80%] of 30 patients with normal renal function had short stature. The univariate analysis identified the presence of hypertension [P=0.0027], heamaturia [P=0.0107] and presence of abnormal renal function [P=0.0001] at presentation, also presence of initial steroid resistance [P=0.0383], resistance to cytotoxic therapy [P=0.0032], capsular adhesions in renal biopsy [P=0.0066], tubular atrophy [P=0.0027], interstitial fibrosis [P=0.0010], all expect to be significant predictors of progression to ESRD. Considering the clinical and histological characteristics of studied patients, apparently our results are comparable to other published series. The progression to chronic kidney disease [CKD] occurs in 30% of patients after 5 years follow-up, must of them with ESRD, this is relatively good out come compared to other studies