Predictors of frequent relapsing and steroid-dependent nephrotic syndrome in children

Dakshayani, B; Lakshmanna, Manjula; Premalatha, R.

doi:10.5152/turkpediatriars.2018.5749

Cited by 10 publications

(11 citation statements)

References 24 publications

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“…Sarkeret al, [13] showed that ages less than 5 years are more prone to have FR compared to those older than 5 years. Dakshayaniet al, [14] followed up 227 Turkish children one year after the first episode and reported that FR had significantly associated with lower age at onset. An almost a similar result was reported by Mishra et al, [15] among Indian children in which the authors found that the risk of FR was 3-time greater in 1-3 year-age compared to children over 6 years.…”

Section: Discussionmentioning

confidence: 99%

Role of urinary tract infections as triggers for frequent relapse in children with steroid sensitive nephrotic syndrome

Shaker¹,

Chaloob²

2020

ATMPH

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Frequent relapse occurs in about 60% of children with steroid-sensitive nephrotic syndrome (SSNS) despite the tangible initial response. Several factors have been documented as triggers for frequent relapses (FR). However, the role of urinary tract infection (UTI) was not well-illustrated. Our aim was to evaluate the role of UTI as a trigger for FR among Iraqi children SSNS. This cross-sectional study was conducted on a total of 68 children with the first episode of SSNS who were followed up for 6 months after taking their treatment for the first episode. The patients were divided into two groups: frequent and infrequent relapse. Midstream urine samples were collected from each child and routine bacteriological culture and detection were achieved. Data regarding age at onset, sex, steroid therapy at the onset, the time between the onset and first relapse were collected from patients' records. The proportion of frequent relapses was 41.18%. UTI affected 22 (32.35%) patients with E. coli was the most common isolated bacteria accounting for 63.64% followed by Klebsiella pneumonia (18.18%), Proteus spp. and Pseudomonas aeruginosa (13.64% for each). In univariate analysis, each of age at onset, inadequate therapy for the first episode, and UTI were significantly associated with frequent relapse. However, in multivariate analysis, only adequate treated for first episode (OR= 0.26, 95%CI= 0.08-0.86, p= 0.028) and UTI (OR= 4.8, 95%CI= 1.22-18.87, p= 0.025) were significantly associated. In conclusion, UTI is an important cause of FR in children with SSNS. Therefore, affected children should be routinely investigated for such infection.

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Section: Discussionmentioning

confidence: 99%

Role of urinary tract infections as triggers for frequent relapse in children with steroid sensitive nephrotic syndrome

Shaker¹,

Chaloob²

2020

ATMPH

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“…Respiratory tract infections (RTI) are common complications of PNS (2,3). Infections not only reduce the efficacy of glucocorticoid treatment but also lead to prolonged duration and frequent recurrence in PNS (4,5). The pathogenic spectrum and their susceptibility to antibiotics in RTI change over time, which increases the difficulty of anti-infection treatment.…”

Section: Introductionmentioning

confidence: 99%

Etiologic Features of Respiratory Tract Infections Seen in Children with Primary Nephrotic Syndrome: A Cross-Sectional Retrospective Study

Xiong

Wang

2020

Iran J Pediatr

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Background: Respiratory tract infections (RTI) are common complications of primary nephrotic syndrome (PNS) and influence the outcomes of PNS. The pathogenic spectrum and their susceptibility to antibiotics in RTI change over time, which increases the difficulty of treatment. Objectives: To improve the curative effect of RTI in children with PNS, we conducted a cross-sectional retrospective study in 2740 children with PNS to study the etiologic features of RTI seen in PNS children. Methods: Totally 2740 children with PNS hospitalized during 2010 - 2014 were enrolled in this study. Respiratory specimens were collected for the detection of pathogens using current laboratory diagnostic tests. The cases were divided into community-acquired respiratory tract infection (CARTI) and hospital-acquired respiratory tract infection (HARTI) as well as upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI) to analyse the etiologic features. Results: Among 2162 cases of PNS with RTI, 2095 cases were CARTI (96.90%), and 67 cases were HARTI (3.10%). The most common pathogen in CARTI was Coxsackie virus, followed by Mycoplasma pneumoniae, respiratory syncytial virus, and Streptococcus pneumoniae, while the most common pathogen in HARTI also was Coxsackie virus, followed by respiratory syncytial virus, Mycoplasma pneumoniae, and Streptococcus pneumoniae. There was significant difference in the positive rates of Pseudomonas aeruginosa and Candida albicans between CARTI and HARTI. The distribution of pathogens differed between URTI and LRTI in children with PNS. The positive rates of most pathogens were lower in URTI than URTI. Generally, the isolation rate of extended-spectrum β-lactamase (ESBL) producing bacteria was relatively low. In CARTI, the sensitive rates of Gram-negative ESBL producing bacteria to carbapenems, amoxicillin/clavulanate potassium, ampicillin/sulbactam, and ciprofloxacin were more than 90.00%, while Gram-positive ESBL producing bacteria were sensitive to glycopeptides, linezolid, macrodantin, mupirocin-HL, and amoxicillin/clavulanate potassium. Conclusions: In children with PNS, the etiology differed between CARTI and HARTI as well as URTI and LRTI. Therefore, it is necessary to differentiate these features for empirical therapy. If the pathogen is bacterial, amoxicillin/clavulanate potassium could be the first choice before sputum culture results are available.

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“…edema, and various complications especially hypovolemia, infection and thrombosis (1) (2) . It is caused by increased permeability through the damaged basement membrane in the renal glomerulus (3) .…”

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confidence: 99%

“…Remission: Urine albumin nil or trace (or proteinuria less than 4 mg/m/h) for 3 consecutive early morning specimens. Relapse: Urine albumin 3+ or 4+ (or proteinuria more than 40 mg/m/h) for 3 consecutive early morning specimens having been in remission previously (2) .…”

mentioning

confidence: 99%

“…Frequent relapses: Two or more relapses in the initial six months or more than three relapses in any twelve months. Steroid dependence: Two consecutive relapses when on alternate day steroid or within 14 days of its discontinuation (2) . While most of the children with primary NS respond to steroid treatment, 10 to 20 % of the patients are steroid resistant (10) .…”

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confidence: 99%

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Nephrotic Syndrome as Initial Episode and Relapse in Iraqi Children.

KhalilAlJuboori¹

2019

IJAR

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Nephrotic syndrome, protein urea and edema. Background: Nephrotic syndrome is a clinical syndrome defined by massive proteinuria responsible for hypo-albuminemia, with resulting hyperlipidemia, edema, and various complications. Aim of the study: to see the clinical presentation of cases of nephrotic syndrome in IRAQI patients and the possible causes of relapses Material and Methods: Forty children with nephrotic syndrome admitted to Al-Mansour Teaching Hospital. A full physical examination was done to each patient and all undergo the following investigations: Urinalysis, urine culture, serum cholesterol, total serum protein, serum protein electrophoresis and chest roentgenogram. Renal biopsy was done only for one patient. The treatment received and the outcome of these cases were recorded. Results: The symptoms of associated infections (fever, cough, abdominal pain, vomiting and diarrhea) were more frequent among the patients with relapse than the newly diagnosed patients. The most obvious sign in all nephrotic patients was edema. Ascites found in (55.5%) of newly diagnosed cases , and in (31.8 %) of patients with relapses , Hypertension (blood pressure more than 95 % for age and sex) .(55.5 %) of patients with relapse who had hypertension , were frequent relapses. Abdominal tenderness was more common among the patients with relapse. Discussion: The peak age incidence in this study was between 1-5 years and there was decreases in incidence below on and above 10 years of age. Edema was found as a symptom and sign. Localized edema in the periorbital area or in the legs at presentation was found only in small number of the patients (15%) this may be due to the delay in the consultation until the edema becomes generalized (table 4 and 5). Generalized edema was the most common presenting symptom in nephrotic patients and oliguria was the next common symptom. Conclusion: Generalized edema was the most common presenting symptom in nephrotic patients and oliguria was the next common symptom.

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Predictors of frequent relapsing and steroid-dependent nephrotic syndrome in children

Cited by 10 publications

References 24 publications

Role of urinary tract infections as triggers for frequent relapse in children with steroid sensitive nephrotic syndrome

Role of urinary tract infections as triggers for frequent relapse in children with steroid sensitive nephrotic syndrome

Etiologic Features of Respiratory Tract Infections Seen in Children with Primary Nephrotic Syndrome: A Cross-Sectional Retrospective Study

Nephrotic Syndrome as Initial Episode and Relapse in Iraqi Children.

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