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

Öz

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.

Anahtar Kelimeler

• Nephrotic syndrome
• steroid treatment
• steroid depended nephrotic syndrome
• child

İdiyopatik Nefrotik Sendromda İlk Atakta Steroid Bağımlılığı Öngörülebilir mi?

Öz

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.

Anahtar Kelimeler

• Nefrotik Sendrom
• Steroid Tedavisi
• Steroid Bağımlı Nefrotik Sendrom
• Çocuk

Kaynakça

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