Journal of Child

SUBMITINFORMATION
EnglishTürkçe

Research Article


DOI :10.26650/jchild.2020.3.807529   IUP :10.26650/jchild.2020.3.807529    Full Text (PDF)

Could Steroid Dependency Be Predicted at the First Attack in Idiopathic Nephrotic Syndrome?

Aysel Taktak, Neslihan Çiçek

Objective: Idiopathic nephrotic syndrome (INS) is the most common glomerular disease in children. Approximately 80% of INS is steroid sensitive (SSNS), and half of SSNS patients are steroid dependent (SDNS). This study determines the risk factors that may predict steroid dependence in patients with SSNS. Material and Method: Patients with SSNS who followed in our Pediatric Nephrology clinic between September 2016 and September 2018 were retrospectively evaluated. The demographic characteristics, albumin, creatinine values, blood pressure, white blood cell, lymphocyte count, lymphocyte/white blood cell ratio, urine protein–creatinine ratio, time to remission, and triggers of the attack were recorded. Results: Twenty-three patients were diagnosed as SSNS and 16 as SDNS. The mean age at presentation was 77.34±32 months in the SSNS group and 73.62±27.32 months in the SDNS group (p=0.690). No significant difference was observed between the two groups in terms of blood albumin, creatinine, lymphocyte count, and lymphocyte/white blood cell ratio. Trigger initiating the attack was more common in the SDNS group (p=0.001). The most common trigger was upper respiratory tract infection. Urine protein/creatinine ratio and white blood cell levels were significantly higher in the SDNS group (p=0.014, p=0.004, respectively), and the time to remission was also longer in the SDNS group (p=0.001). Conclusion: Upper respiratory tract infection may be a trigger, and severe proteinuria and late remission time may be risk factors for the development of SDNS in INS. Early use of steroid-sparing agents in these patients can prevent long-term adverse effects of steroid therapy.

Keywords: Nephrotic syndrome, steroid treatment, steroid depended nephrotic syndrome, child
DOI :10.26650/jchild.2020.3.807529   IUP :10.26650/jchild.2020.3.807529    Full Text (PDF)

İdiyopatik Nefrotik Sendromda İlk Atakta Steroid Bağımlılığı Öngörülebilir mi?

Aysel Taktak, Neslihan Çiçek

Amaç: İdiyopatik nefrotik sendrom (İNS) çocuklarda en sık görülen glomerüler hastalık olup, %80’i steroide duyarlıdır. Steroide duyarlı nefrotik sendrom (SDNS) hastalarının yaklaşık yarısı steroid bağımlı nefrotik sendromudur (SBNS). Bu çalışmanın amacı ilk atağında başvuran SDNS hastalarında, steroid bağımlılığını tedavi öncesi öngörebilecek risk faktörlerini belirlemektir. Gereç ve Yöntem: Çocuk Nefroloji Kliniğimize Eylül 2016-Eylül 2018 tarihleri arasında ilk atak İNS ile başvuran ve steroid tedavisine yanıtlı hastalar geriye dönük olarak değerlendirildi. Hastaların demografik özellikleri, poliklinik kan basıncı ölçümü, kan albümin ve kreatinin değeri, beyaz küre sayısı, lenfosit sayısı, lenfosit/beyaz küre oranı, spot idrar protein/kreatinin oranı, steroid tedavisi başlanmasını takiben remisyona girme süresi ve atak başlatıcısı kaydedildi. Bulgular: Hastaların 23’ü SDNS, 16’sı SBNS tanısı aldı. Başvuru yaşı ortalaması SDNS grubunda 77,34±32 ay, SBNS grubunda 73,62±27,32 ay idi (p=0,690). İki grup arasında kan albümin, kreatinin, lenfosit sayısı ve lenfosit/beyaz küre oranı açısından anlamlı fark saptanmadı. Atak başlatıcısı SBNS grubunda daha fazla görüldü (p=0,001) ve en sık tespit edilen atak başlatıcısı üst solunum yolu enfeksiyonu idi. Spot idrar protein/kreatinin oranı, kan beyaz küre seviyesi SBNS grubunda anlamlı yüksek saptandı (p=0,014, p=0,004) ve remisyona girme süresi SBNS grubunda daha uzundu (17,5 güne 9 gün) (p=0,000). Sonuç: İdiyopatik NS’de, üst solunum yolu enfeksiyonuyla ilk atağın tetiklenmesi, başvuru anında ağır proteinüri saptanması ve geç remisyona girme süresi SBNS gelişmesi açısından risk faktörleri olabilir. Bu hastalarda steroid ayırıcı tedavilerin daha erken gündeme alınması, steroid tedavisinin istenmeyen uzun dönem yan etkilerinden koruyacaktır.

Keywords: Nefrotik Sendrom, steroid tedavisi, steroid bağımlı nefrotik sendrom, çocuk

PDF View

References

  • 1. Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet 2003 Aug 23;362(9384):629-39. google scholar
  • 2. Niaudet P, Boyer O. Idiopathic nephrotic syndrome in children: Clinical aspects in a textbook of pediatric nephrology. In: Avner D et al. (eds). 7th ed; 2016. pp. 839-82. google scholar
  • 3. Kang HG, Cheong HI. Nephrotic syndrome: what’s new, what’s hot? Korean J Pediatr 2015 Aug;58(8):275-82. google scholar
  • 4. Gipson DS, Massengill SF, Yao L, Nagaraj S, Smoyer WE, Mahan JD, et al. Management of childhood onset nephrotic syndrome. Pediatrics 2009 Aug;124(2):747-57. google scholar
  • 5. Park SJ, Shin JI. Complications of nephrotic syndrome. Korean J Pediatr 2011 Aug;54(8):322-8. google scholar
  • 6. Sinha A, Hari P, Sharma PK, Gulati A, Kalaivani M, Mantan M, et al. Disease course in steroid sensitive nephrotic syndrome. Indian Pediatr 2012 Nov;49(11):881-7. google scholar
  • 7. Dawman L, Mehta A, Sharawat IK, Yadav R. Risk factors for steroid dependency in children with idiopathic nephrotic syndrome in India. Indian J Pediatr 2016 Mar;83(3):261. google scholar
  • 8. Andersen RF, Thrane N, Noergaard K, Rytter L, Jespersen B, Rittig S. Early age at debut is a predictor of steroid-dependant and frequently relapsing nephrotic syndrome. Pediatr Nephrol 2010 Jul;25(7):1299-304. google scholar
  • 9. Kabuki N, Okugawa T, Hayakawa H, Tomizawa S, Kasahara T, Uchiyama M. Influence of age at onset on the outcome of steroid-sensitive nephrotic syndrome. Pediatr Nephrol 1998 Aug;12(6):467-70. google scholar
  • 10. Abdel-Hafez MA, Abou-El-Hana NM, Erfan AA, El-Gamasy M, Abdel- Nabi H. Predictive risk factors of steroid-dependent nephrotic syndrome in children. J Nephropathol 2017Jul;6(3):180-6. google scholar
  • 11. Dakshayani B, Lakshmanna M, Premalatha R. Predictors of frequent relapsing and steroid-dependent nephrotic syndrome in children. Turk Pediatri Ars 2018 Mar 1;53(1):24-30. google scholar
  • 12. Rai VK, Awasthi S, Venkatesh V. Prediction of early response to steroids in nephrotic syndrome patients aged between 2 and 10 years. Clin Epidem and Glob Health 2017 Dec;5(4):203-8. google scholar
  • 13. MacDonald NE, Wolfish N, McLaine P, Phipps P, Rossier E. Role of respiratory viruses in exacerbations of primary nephrotic syndrome. J Pediatr 1986 Mar;108(3):378-82. google scholar
  • 14. Takahashi S, Wada N, Murakami H, Funaki S, Inagaki T, Harada K, et al. Triggers of relapse in steroid-dependent and frequently relapsing nephrotic syndrome. Pediatr Nephrol 2007 Feb;22(2):232-6. google scholar
  • 15. Letavernier B, Letavernier E, Leroy S, Baudet-Bonneville V, Bensman A, Ulinski T. Prediction of high-degree steroid dependency in pediatric idiopathic nephrotic syndrome. Pediatr Nephrol 2008 Dec;23(12):2221-6. google scholar
  • 16. Niaudet P. Long-Term outcome of children with steroid-sensitive idiopathic nephrotic syndrome. Clin J Am Soc Nephrol 2009 Oct;4(10):1547-8. google scholar
  • 17. Fakhouri F, Bocquet N, Taupin P, Presne C, Gagnadoux MF, Landais P, et al. Steroid-sensitive nephrotic syndrome: from childhood to adulthood. Am J Kidney Dis 2003 Mar;41(3):550-7. google scholar

Citations

Copy and paste a formatted citation or use one of the options to export in your chosen format


EXPORT



APA

Taktak, A., & Çiçek, N. (2020). Could Steroid Dependency Be Predicted at the First Attack in Idiopathic Nephrotic Syndrome?. Journal of Child, 20(3), 96-99. https://doi.org/10.26650/jchild.2020.3.807529


AMA

Taktak A, Çiçek N. Could Steroid Dependency Be Predicted at the First Attack in Idiopathic Nephrotic Syndrome?. Journal of Child. 2020;20(3):96-99. https://doi.org/10.26650/jchild.2020.3.807529


ABNT

Taktak, A.; Çiçek, N. Could Steroid Dependency Be Predicted at the First Attack in Idiopathic Nephrotic Syndrome?. Journal of Child, [Publisher Location], v. 20, n. 3, p. 96-99, 2020.


Chicago: Author-Date Style

Taktak, Aysel, and Neslihan Çiçek. 2020. “Could Steroid Dependency Be Predicted at the First Attack in Idiopathic Nephrotic Syndrome?.” Journal of Child 20, no. 3: 96-99. https://doi.org/10.26650/jchild.2020.3.807529


Chicago: Humanities Style

Taktak, Aysel, and Neslihan Çiçek. “Could Steroid Dependency Be Predicted at the First Attack in Idiopathic Nephrotic Syndrome?.” Journal of Child 20, no. 3 (Nov. 2024): 96-99. https://doi.org/10.26650/jchild.2020.3.807529


Harvard: Australian Style

Taktak, A & Çiçek, N 2020, 'Could Steroid Dependency Be Predicted at the First Attack in Idiopathic Nephrotic Syndrome?', Journal of Child, vol. 20, no. 3, pp. 96-99, viewed 23 Nov. 2024, https://doi.org/10.26650/jchild.2020.3.807529


Harvard: Author-Date Style

Taktak, A. and Çiçek, N. (2020) ‘Could Steroid Dependency Be Predicted at the First Attack in Idiopathic Nephrotic Syndrome?’, Journal of Child, 20(3), pp. 96-99. https://doi.org/10.26650/jchild.2020.3.807529 (23 Nov. 2024).


MLA

Taktak, Aysel, and Neslihan Çiçek. “Could Steroid Dependency Be Predicted at the First Attack in Idiopathic Nephrotic Syndrome?.” Journal of Child, vol. 20, no. 3, 2020, pp. 96-99. [Database Container], https://doi.org/10.26650/jchild.2020.3.807529


Vancouver

Taktak A, Çiçek N. Could Steroid Dependency Be Predicted at the First Attack in Idiopathic Nephrotic Syndrome?. Journal of Child [Internet]. 23 Nov. 2024 [cited 23 Nov. 2024];20(3):96-99. Available from: https://doi.org/10.26650/jchild.2020.3.807529 doi: 10.26650/jchild.2020.3.807529


ISNAD

Taktak, Aysel - Çiçek, Neslihan. “Could Steroid Dependency Be Predicted at the First Attack in Idiopathic Nephrotic Syndrome?”. Journal of Child 20/3 (Nov. 2024): 96-99. https://doi.org/10.26650/jchild.2020.3.807529



TIMELINE


Submitted10.08.2020
Accepted03.11.2020
Published Online30.12.2020

LICENCE


Attribution-NonCommercial (CC BY-NC)

This license lets others remix, tweak, and build upon your work non-commercially, and although their new works must also acknowledge you and be non-commercial, they don’t have to license their derivative works on the same terms.


SHARE




Istanbul University Press aims to contribute to the dissemination of ever growing scientific knowledge through publication of high quality scientific journals and books in accordance with the international publishing standards and ethics. Istanbul University Press follows an open access, non-commercial, scholarly publishing.