Clinical Study on Idiopathic Nephrotic Syndromein Children

ABSTRACT

A clinical observation was done on 38 children with idiopathic nephrotic syndrome, who had been admitted to our pediatric department during past 3 years period, from January 1978 to September 1980. The following results were obtained At the beginning of illness, 42% were in the age group of 3~7year, and male to female ratio was approximately 31 of male preponderance. During initial attack and subsequent relapses, pitting edema on extremities was noticed in all cases, followed in frequency by generalized edema in 71%, ascites and /or pleural effusion in 65.8% and GI trouble in 47.4%. Response to initial continuous steroid therapy showed complete remission(group 4) in 37.8%, partial remission(group 23) in 46% and no response(group 1) in 16.2%, Within 2 weeks after instiution of steroid therapy, both diuresis and disappearance of proteinuria were noted in 57.1%. Nephritic manifestations, eg. Hematruia, hypertension & azotemia, were seen in 21.6%, 10.8%, 24.3% respectively, and the majority of children with these manifestations showed poor response to steroid therapy. Nine out of 21 patients in whon follow-up could be done over 1 year, experienced one or more relapses, giving 43% relapse rate during the 1st year, and URI was accompanied in about half of these episodes. Percutaneous renal biopsy done on 17 patients who showed steroid dependency or no response to poor response toward steroid therapy showed the following results: Minimal change nephrotic syndrome in 8, membranous nephropathy in 3, membranoproliferative glomerulonephritis in 3, focal segmental sclerosis in 1 and focal proliferative glomerulonephritis in 2. And male to female ratio was 134. ?Pulse?therapy with bolus dosasge of methylprednisolone was tried on 9 patients, resulting in disappearance of relapse or significant improvement in blood chemistry & urinary finding in 5. And 2 out of 5 patients in whom immunosuppressant therapy with cytoxan was giveu due to poor response to steroid, experienced complete remission. During the same study period, secondary nephrotic syndrome was observed in 6 out of 54 patients with acute glomerulonephritis, and heavy proteinuria over 2 gm/m2/day, was seen in 6 patients with acute glomerulonephritis and 2 patients with congestive heart failure.