Proteinuria selectivity and prednisone response in children with nephrotic syndrome

Authors

  • Gustavo Pérez-Cortés <p>Nuevo Hospital Civil de Guadalajara &ldquo;Dr. Juan I. Menchaca&rdquo;, Divisi&oacute;n de Pediatr&iacute;a, Servicio de Nefrolog&iacute;a Pedi&aacute;trica. Guadalajara, Jalisco</p>
  • J. Jesús Pérez-Molina <p>Nuevo Hospital Civil de Guadalajara &ldquo;Dr. Juan I. Menchaca&rdquo;, Subdirecci&oacute;n de Ense&ntilde;anza e Investigaci&oacute;n. Guadalajara, Jalisco</p>
  • Cristina Ochoa-Ponce <p>Nuevo Hospital Civil de Guadalajara &ldquo;Dr. Juan I. Menchaca&rdquo;, Divisi&oacute;n de Pediatr&iacute;a, Servicio de Nefrolog&iacute;a Pedi&aacute;trica. Guadalajara, Jalisco</p>
  • Santa Ramírez-Godínez <p>Instituto Mexicano del Seguro Social, Centro M&eacute;dico Nacional de Occidente, Hospital de Pediatr&iacute;a, Divisi&oacute;n de Nefro-Urolog&iacute;a. Guadalajara, Jalisco</p>
  • Vania Marcela Ornelas-Álvarez <p>Nuevo Hospital Civil de Guadalajara &ldquo;Dr. Juan I. Menchaca&rdquo;, Divisi&oacute;n de Pediatr&iacute;a, Servicio de Nefrolog&iacute;a Pedi&aacute;trica. Guadalajara, Jalisco</p>

Keywords:

Nephrotic Syndrome, Proteinuria, Prednisone, Treatment Outcome

Abstract

Background: The proteinuria selectivity index (PSI) can predict the response to prednisone in the primary nephrotic syndrome (PNS).

Objective: To determine the association of prednisone response with the PSI in patients with PNS.

Material and methods: With analytical cross-sectional design, pediatric patients with PNS were studied with at least six months of prior follow-up, at the Nuevo Hospital Civil de Guadalajara from 2014 to 2015. They were divided into poor response to prednisone (frequent relapses or resistance) and good response (habitual relapses). PSI was calculated with serum and urinary measurement of IgG and transferrin. Chi square and OR were used, with 95% CI.

Results: 67 patients with relapsing PNS were studied. The response to prednisone had been good in 33 (49.3%) and poor in 34 (50.7%). The PSI was ≤ 0.10 mg/mg in 23/67 (34.3%); 0.11-0.19 mg/mg in 15/67 (22.4%); and ≥ 0.20 mg/mg 29/67 (43.3%). 3/34 patients (8.8%) presented ≤ 0.1 mg/mg with poor response to prednisone and 20/33 presented good response (60.6%) (p < 0.001; OR: 0.6; 95% CI, 0.010-20). PSI between 0.11-0-19 mg/mg occurred in 8/34 patients (23%) with poor response to prednisone and in 7/33 with good response (21%). PSI ≥ 0.20 mg/mg resulted in 23/34 patients (67.6%) with poor response to the steroid and in 6/33 with good response (18.2%) (p < 0.001; OR: 9.4; 95% CI, 3.01-29.42).

Conclusions: In children with PNS, a PSI ≥ 0.20 mg/mg was associated with a poor response to prednisone treatment and a PSI ≤ 0.10 mg/mg with a satisfactory response.

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References

Nephrotic syndrome in children:prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. A report of the International Study of Kidney Disease in Children. Kidney Int. 1978;13(2):159-65.

 

Gipson DS, Massengill SF, Yao L, Nagaraj S, Smoyer WE, Mahan JD, et al. Management of childhood onset nephrotic syndrome. Pediatrics. 2009;124(2):747-57. doi:10.1542/peds.2008-1559

 

Sinha A, Bagga A. Nephrotic syndrome. Indian J Pediatr. 2012;79(8):1045-55. doi:10.1007/s12098-012-0776

 

Blainey JD, Brewer DB, Hardwicke J, Soothill JF. The nephrotic syndrome. Diagnosis by renal biopsy and biochemical and immunological analysis related to the response to steroid therapy. QJ Med. 1960;23(1):235-9.

 

Joachim G, Cameron S. Selectivity of protein excretion in patients with the nephrotic syndrome. J Clin Invest. 1964;43(12):2332-45.

 

Cameron JS, White RHR. Selectivity of proteinuria in children with nephrotic syndrome. Lancet. 1965;285(7383):463-5.

 

Cameron JS, Blandford G. The simple assessment of selectivity in heavy proteinuria. Lancet. 1966;288(7457):242-7.

 

Laurent J, Philippon C, Lagrue G, Laurent G, Weil B, Rostoker G. Proteinuria selectivity index prognostic value in lipoid nephrosis and related diseases. Nephron. 1993;65(2):185-9.

 

Zaki M, Deasy PF, Daoud A. Proteinuria selectivity in childhood nephrotic syndrome. Baharain Med Bull. 1997;19(1):16-8.

 

Abdurrahman MB, El Sheikh OK, Elidrissy TH, Al Kahtani WM, Lambourne A. Proteinuria selectivity index in Saudi children with nephrotic syndrome. Ann Clin Biochem. 1989;26(pt6):492-5.

 

Bazzi C, Petrini P, Rizza V, D'Amiko G. A modern approach to selectivity of proteinuria and a tubulointerstitial damage in nephrotic syndrome. Kidney Int. 2000;58(4):1732-41.

 

Tarshish P, Tobin JN, Bernstein J, Edelmann CM Jr. Prognostic significance of the early course of minimal change nephrotic syndrome:report of the International Study of Kidney Disease in Children. J Am Soc Nephrol. 1997;8(5):769-76.

 

Hulley SB, Cummings SR, Newman TB. Diseño de estudios transversales y de cohortes. En:Hulley SB, Cummings SR, Broener WS, Grady DG, Newman TB, editores. Diseño de investigaciones clínicas. 4.ªed. Barcelona:Wolters Kluwer;2014. 85-96.

 

Schwartz GJ, Schneider MF, Maler PS, Moxey-Mims M, Dharnidharka VR, Warad B, et al. Improved equation estimating GFR in children with chronic kidney disease using an immunonephelometric determination of cystatin C. Kidney Int. 2012;82(4):445-53. doi:10.1038/ki.2012.169

 

Early identification of frequent relapse among children with minimal change nephrotic syndrome. A report of the International Study of Kidney Disease in Children. J Pediatr. 1982;101(4):514-8.

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Published

2021-07-30

Issue

Vol. 58 No. 3 (2020): May-June

Section

Original Articles

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