Options of the treatment in steroid resistant nephrotic syndrome in children in central child teaching hospital-Baghdad

The therapy of steroid resistant nephritic syndrome [SRNS] is still a matter of controversy. To assess the options of treatment in SRNS. A retrospective study to 50 patient randomly selected in the Central Child Teaching Hospital during study period from Jan. 2006 till July 2008. The patient age was between 6 months - 18 years. All patients who had failed to achieve an improvement in proteinuria after minimum of 4 weeks [up to 8 weeks] of prednisolone [PDN] in a dosage 2 mg/kg/day were taken. Only the patients with idiopathic nephritic syndrome [45 patients] were involved in the study but the patients with secondary nephritic syndrome and congenital neprosis were excluded from the study. Each patient were individualized to the type of pathology and to the type of medication used. Forty five patients were included in the study, the age range between 6 months -18 years. Twenty eight patients were male and 17 were female, M: F ration 1.64: 1 regarding the type of pathology, 20 patients with focal segmental glomerulosclerosis [FSGS], 11 patients with minimal change nephritic syndrome [MCNS], 8 patients with diffuse mesagnial proliferation [DMP] and 6 patients were unknown biopsy [not down biopsy]. The drugs that used were methyl prednisolone [MP] in 17 patients. Every other day steroid [EODS] in 10 patients, cyclosporine A [CsA] plus EODS in 16 patients [10 patients as first option and 6 patients as second option, cyclophosphamide [CYS] used in 8 patients [6 patients as first option and 2 patients as second option] and chlorambucil wee used in 2 patients only. The response was higher in patients who received EODS [50%], followed by the patients who received CsA plus EODS [25%] then the patients who received MP [23.5%] and the patients who received CYS [12.5%] and chlorambucil [zero%]. The response to treatment was higher in females than males, 11 out of 28 males [39.28%] responded to treatment while 7 of 17 female [41.17%] responded to treatment. The patients with early presentation responded to treatment higher than those with late presentation, so 12 of 19 patients [63.15%] presented early while 10 of 26 patients [38.46%] presented ate. According to histopathology, the patients with unknown etiology had higher rate of response, 3 out of 6 patients [50%] responded to treatment followed by 7 of 20 [35%] patients with FSGS, then 2 of 8 [25%] patients with DMP, then 2 of 11 [18.18%] patients with MCNS. The drugs used are the common drugs and EODS is preferable type of medication used in SRNS

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