Abstract

BOLANOS, Laercio  and  CASTANO, Iris de. Clinical and histopathologic characteristics of primary nephrotic syndrome. Colomb Med [online]. 2005, vol.36, n.1, pp.29-33. ISSN 1657-9534.

INTRODUCTION: The presentation of nephrotic syndrome with severe proteinuria, hypoalbuminemia, generalized edema and his treatment with high-dose of steroides, force the clinicial to recognize and treat opportunely. Also must have the ability to predict the outcome and prognosis of the disease after the initial treatment. OBJECTIVES: To know the behavior of primary nephrotic syndrome in children in Cali and peripheral areas, the demographic profiles, the clinical presentation, the response to treatment the histopathology classification and recommendation for renal biopsy. DESIGN AND METHODS: From January 1986 to July 2002, 264 medical records of children with primary nephrotic syndrome between 1 to 15 years old were reviewed. RESULTS: The mean age for the diagnosis was 4 years, 60% of the patients were males and 40% females. All the patients presented with edema and massive proteinuria, 97% hypoalbuminemia, 94% hypercholesterolemia and 54% oliguria. The response to therapy with corticosteroids was 89% and 11% were corticoresistent: this percentage is lower than other series which report up to 30% corticosteroid resistence. In 65 patients with frequent relapsing we observed good response to cyclophosfamide in 40%. Renal biopsy was performed in 73 patients; the indication for the biopsy was no response to steroid therapy in 29%, frequent relapses and steroid dependence in 71%. The diagnosis in these 73 biopsies was minimal changes 36%, mesangial proliferation 46%, focal segmental glomeruloesclerosis 11%, and other pathologies 7%. CONCLUSIONS: We observed low frequency of corticosteroid resistence patients and focal segmental glomeruloesclerosis than other series. We recommend the use of cyclophosfamide in frequent relapsing patients before doing a renal biopsy. Renal biopsy is recommended in corticoid resistent patients. Only 40% of the patients had complete follow up in nephrology outpatient clinic. It is important to improve follow up of nephrotic patients.

Keywords : Idiopathic nephrotic syndrome; Response to steroid therarpy; Citotoxic; Renal biopsy.

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