Pharmaceutical Sciences: Recent Advances and Treatments of Childhood Nephrotic Syndrome

IAJPS 2020, 07 (10), 5-7 Sarwar Rafique et al ISSN 2349-7750
CODEN [USA]: IAJPBB ISSN : 2349-7750
INDO AMERICAN JOURNAL OF

PHARMACEUTICAL SCIENCES
SJIF Impact Factor: 7.187
http://doi.org/10.5281/zenodo.4062190
Available online at: http://www.iajps.com Research Article
RECENT ADVANCES AND TREATMENTS OF CHILDHOOD

NEPHROTIC SYNDROME
Dr. Sarwar Rafique1, Dr. Uswa Majeed1, Dr. Sumaira Rafique1
1
Nishtar Hospital, Multan
Article Received: August 2020 Accepted: September 2020 Published: October 2020
Abstract:
Introduction: Nephrotic syndrome is characterized by gross proteinuria, hypo albuminemia, hyperlipidemia, and
peripheral edema. The etiology of nephrotic syndrome in adults is complex and ranges from primary
glomerulonephritis to secondary forms. Objectives of the study: The main objectives of the study is to find the
recent advances and treatments of childhood nephrotic syndrome in Pakistan. Methodology of the study: This
analytical study was conducted at Nishtar Hospital, Multan during 2019. The data was collected from 100 patients
of both genders which was suffering from nephrotic syndrome. The basic purpose of this data is to find and
investigate the recent advances and treatments of nephrotic syndrome in Pakistani hospitals. Results: The study
group comprised of 100 patients 72 (93.5%) were initial steroid resistant and 28 were late non-responders.
Gender distribution showed 49 (63.6%) males and 28 (36.4%) females with a ratio of 1.75. Age range of patients
was 1-15 years with a mean of 8.11 +3.58 years. Sixty nine (89.6%) patients underwent renal biopsy. Patients
with focal segmental glomerulo sclerosis (FSGS) were least likely to respond to treatment followed by mesangio
proliferative glomerulonephritis and minimal change disease. Conclusion: Nephrotic syndrome can increase
your child’s risk of infection and blood clots. It always affects both kidneys and usually appears in the early years
of your child’s life. Most children with this disorder outgrow it by young adulthood. We conclude that NS in
children is a difficult disease with significant morbidity.
Corresponding author:
Dr. Sarwar Rafique *, QR code
Nishtar Hospital, Multan
Please cite this article in press Sarwar Rafique et al, Recent Advances And Treatments Of Childhood
Nephrotic Syndrome., Indo Am. J. P. Sci, 2020; 07(10).
www.iajps.com Page 5
INTRODUCTION: Objectives of the study

Nephrotic syndrome is characterized by gross The main objectives of the study is to find the recent
proteinuria, hypo albuminemia, hyperlipidemia, and advances and treatments of childhood nephrotic
peripheral edema. The etiology of nephrotic syndrome in Pakistan.
syndrome in adults is complex and ranges from
primary glomerulonephritis to secondary forms. METHODOLOGY OF THE STUDY:
Primary forms of nephrotic syndrome in adults are This analytical study was conducted at Nishtar
comprised of three histological disease entities: Hospital, Multan during 2019. This study was done
idiopathic membranous nephropathy (iMN), according to the rules and regulations of hospital
minimal change disease (MCD), and focal ethical authority. The data was collected from 100
segmental glomerulo sclerosis (FSGS)1. The basis patients of both genders which was suffering from
for therapy of primary nephrotic syndrome is mostly nephrotic syndrome. The basic purpose of this data
of supportive nature. Supportive strategies include is to find and investigate the recent advances and
antihypertensive and anti-proteinuric therapy and treatments of nephrotic syndrome in Pakistani
dietary recommendations. Patients with nephrotic hospitals. The main objectives in management of
syndrome are also at increased risk to develop nephrotic syndrome are to induce quick remission to
thromboembolism. In patients with membranous ensure freedom from edema and consequences of
nephropathy, the adjusted hazard ratio for persistent nephrotic state such as hyperlipidemia,
thromboembolism was 10.8 compared to patients protein malnutrition, thromboembolic episodes,
with IgA nephropathy3. In contrast, for patients with severe infections, etc. Demographic data of the
FSGS the hazard ratio was 5.9. Hence, anticoagulant patients, treatment received, and outcome of
therapy is recommended in patients with a primary treatment and complications were recorded.
nephrotic syndrome, especially in iMN and serum Statistical analysis
albumin < 2.5 mg/dl. In 2014, Lee et al. proposed a A chi-square test was used to examine the difference
practical approach to prophylactic anticoagulation in the distribution of the fracture modes (SPSS 19.0
therapy in patients with iMN. The presented model for Windows, SPSS Inc., USA).
takes into account the serum albumin concentration,
the individual patient’s bleeding risk, and the risk RESULTS:
tolerance as reflected by the selected benefit-to risk The study group comprised of 100 patients 72
ratio3. (93.5%) were initial steroid resistant and 28 were
late non-responders. Gender distribution showed 49
Idiopathic, or primary, nephrotic syndrome is often (63.6%) males and 28 (36.4%) females with a ratio
used to describe the group of patients for whom no of 1.75. Age range of patients was 1-15 years with a
specific cause has been identified, and the histology mean of 8.11 +3.58 years. Sixty nine (89.6%)
is relatively non-specific4. These patients will patients underwent renal biopsy. Patients with focal
usually receive immunosuppression without segmental glomerulosclerosis (FSGS) were least
knowledge of the mechanism and be categorized likely to respond to treatment followed by mesangio
according to response. So the challenge is to proliferative glomerulonephritis and minimal
understand and categorize the underlying injury at a change disease.
molecular level and therefore adapt treatments
according to the likely mechanism5.
Table 01: Demography of 100 selected patients
Category Number (%age)
Biopsied 69(89.6%)
Un biopsied 08(10.4%)
Initial SR 72(93.5%)
Late SR 05(6.5%)
Males 49(63.6%)
Females 28(36.4%)
Age(Years)
<4 22(28.6%)
4-10 31(40.2%)
>10 24(31.2%)
The patients in group 1 received CsA plus PDN, MMF plus PDN, combined CsA and MMF plus PDN, and
intravenous MP pulses + oral PDN and CPM as S1,S2, S3, and S4 treatment respectively. Following S1, 31/61
patients (50.8%) achieved complete remission, 5/61 (8.2%) were partial responders, and 25/61 (41%) were non-
responders.
Table 02: Treatment of nephrotic syndrome

Sequential Drugs Number of Complete Partial No Remission
Treatment Step Patients Remission Remission
Step 1 CsA + PDN 61 (79.2%) 31 (50.8%) 05 (8.2%) 25 (41%)
Step 2 MMF + PDN 30 (49.2%) 03 (4.9%) 07 (11.5%) 20 (32.8%)
Step 3 CsA + MMF +PDN 27 (44.3%) 06 (9.8%) 09 (14.8%) 12 (19.7%)
Step 4 IVMP + 21 (34.4%) 04 (6.6%) 02 (3.3%) 15 (24.6%)
PDN + CPM
Total: Steps 1-4 61 (100%) 44 (72%) 02 (3.3%) 15 (24.6%)
DISCUSSION: REFERENCES:
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IAJPS 2020, 07 (10), 5-7 Sarwar Rafique et al ISSN 2349-7750

CODEN [USA]: IAJPBB ISSN : 2349-7750

INDO AMERICAN JOURNAL OF

Available online at: http://www.iajps.com Research Article

RECENT ADVANCES AND TREATMENTS OF CHILDHOOD

INTRODUCTION: Objectives of the study

Table 02: Treatment of nephrotic syndrome

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