Factors of corticosteroid resistant nephrotic syndrome progression in children

¹ Ural State Medical University, Faculty of Paediatrics, 620028 Ekaterinburg, Russian Federation
² Regional Children’s Clinical Hospital, Department of hospital paediatrics, 620149, Ekaterinburg, Russian Federation

^* Corresponding author: jurnas178@yandex.ru

Abstract

Nephrotic syndrome (NS) is one of the most severe kidney pathologies. NS often relapses and becomes resistant to immunosuppressive therapy. In order to identify factors that prevent NS relapses development and possible increase of therapy effectiveness, we have analyzed the course nature of primary (idiopathic) and secondary frequently relapsing steroid-resistant nephrotic syndrome (FRNS) in 22 children who received immunosuppressive therapy (IS) (cyclosporin (CSA) or mycophenolic acid (MPA)). As a result of the study, the following factors of NS progression in observed children were revealed: hereditary predisposition for diseases of urinary system organs; presence of more than 5 small external abnormalities development, greater disease record, presence of herpetic infection and chronic infection focal points. In children with long disease experience, a reliably higher level of proteinuria was identified. At the time of examination, stage I chronic kidney disease was registered in most children, one in five children had stage II CKD. CKD stage was not dependent on the type of immunosuppressive therapy received (p<0.05). For children who had NS activity persistence at the time of the study, it was recommended to re-perform nephrobiopsy in order to verify morphological changes in the kidneys, correction – including the institution of alternative immunosuppressive therapy.