Clinicopathologic Correlates Predict the Outcome in Children With Steroid-Resistant Idiopathic Nephrotic Syndrome Treated With Pulse Methylprednisolene Therapy

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Although pulse methylprednisolone therapy (PMT) has been used successfully in the management of children with steroid-resistant nephrotic syndrome (SRNS), the relationship between initial presenting findings and renal histological characteristics to the subsequent clinical response to PMT is unknown. A retrospective analysis was conducted in a study cohort of 42 children (30 boys, 12 girls; mean age, 7.4 +/- 4.7 years) with SRNS administered PMT between June 1976 and July 1994 at Stanford University (Stanford, CA). Four diagnostic categories were created: group I, minimal change disease with or without mesangial hypercellularity (n = 10); group II, mesangial proliferation (n = 7); group III, focal segmental glomerulosclerosis (FSGS) with or without mesangial hypercellularity (n = 10); and group IV, FSGS plus mesangial proliferation (n = 15). Primary variables analyzed were remission in response to PMT with or without alkylating agent therapy and end-stage renal disease (ESRD). Remission rates were best in group I (90%) and worst in group IV (46%). With the exception of hematuria, presenting clinical features did not correlate with outcome. Segmental sclerosis, glomerular adhesion to Bowman's capsule, epithelia[ sloughing, corona (segmental scar surrounded by visceral epithelial cells), subepithelial deposits, inflammatory cells, and percentage of interstitium, immunoglobulin M (IgM), IgG, and C3 deposition univariately correlated with ESRD in univariate analysis. In a multivariate logistic regression model, only segmental sclerosis (P = 0.008) correlated with ESRD. Histological analysis is important because it identifies features, including segmental sclerosis, that portend a poor prognosis in children with SRNS. (C) 2002 by the National Kidney Foundation, Inc.
Publisher
W B Saunders Co-Elsevier Inc
Issue Date
2002-06
Language
English
Article Type
Article
Keywords

FOCAL-SEGMENTAL GLOMERULOSCLEROSIS; INTRAVENOUS METHYLPREDNISOLONE; COLLAPSING GLOMERULOPATHY; ALKYLATING-AGENTS; PODOCYTES; DISEASE; PHENOTYPE; SCLEROSIS; FEATURES; DAMAGE

Citation

AMERICAN JOURNAL OF KIDNEY DISEASES, v.39, no.6, pp.1143 - 1152

ISSN
0272-6386
DOI
10.1053/ajkd.2002.33382
URI
http://hdl.handle.net/10203/5614
Appears in Collection
ITM-Journal Papers(저널논문)
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