Pediatric Nephrology

, Volume 19, Issue 6, pp 633–637 | Cite as

The prognostic value of glomerular immaturity in the nephrotic syndrome in children

  • Danuta Ostalska-Nowicka
  • Jacek Zachwieja
  • Janusz Maciejewski
  • Aldona Woźniak
  • Wiesława Salwa-Żurawska
Original Article

Abstract

The study group consisted of 16 children (9 boys and 7 girls) aged 6–52 months (mean age 27 months) with a first episode of nephrotic syndrome. Histological diagnosis (diffuse mesangial proliferation with signs of glomerular immaturity) was established by renal biopsy. The control group consisted of 47 children (26 boys and 21 girls) aged 7–58 months (mean 29 months) hospitalized with a first episode of nephrotic syndrome with diffuse mesangial proliferation, documented exclusively by histological examination. The aim of the study was to analyze the clinical course of a first episode of nephrotic syndrome in children with diffuse mesangial proliferation with and without signs of glomerular immaturity. In children with a first episode of the nephrotic syndrome and glomerular immaturity steroid resistance was more frequent (P=0.0234). Furthermore, in the study group there was a less favorable clinical course of the disease in children younger than 1 year of age and with an original serum albumin concentration lower than 1.0 g/dl. Hence, the presence of relatively rare signs of glomerular immaturity influences unfavorably the course and treatment of nephrotic syndrome in children.

Keywords

Primary nephrotic syndrome Diffuse mesangial proliferation Immature glomeruli Steroid resistance 

References

  1. 1.
    Bergstein JM (2000) Nephrology. In: Behrman RE, Kliegman RM, Jenson HB (ed) Nelson textbook of pediatrics, 16th edn. Saunders, Philadelphia, p 1592Google Scholar
  2. 2.
    White RHR, Glasgow EF, Mills RJ (1970) Clinicopathological study of nephrotic syndrome in childhood. Lancet I:1353–1358CrossRefGoogle Scholar
  3. 3.
    Waldherr R, Gubler MC, Levy M, Broyer M, Habib R (1978) The significance of pure diffuse mesangial proliferation in idiopathic nephrotic syndrome. Clin Nephrol 10:171–179PubMedGoogle Scholar
  4. 4.
    Churg J, Habib R, White RHR (1970) Pathology of the nephrotic syndrome in children. Lancet 760:1299–1302CrossRefPubMedGoogle Scholar
  5. 5.
    Report of the International Study of Kidney Disease in Children (1981) The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. J Pediatr 98:561–564PubMedGoogle Scholar
  6. 6.
    Woźniak A, Salwa-Żurawska W, Żurawski J, Ostalska-Nowicka D (2003) An immunohistochemical and electron-microscopic study of immature glomeruli in children with nephrotic syndrome glomerulopathies (in relation with clinical findings). Nephrol Dial Transplant 18 [Suppl 4]:810–811Google Scholar
  7. 7.
    Nash MA, Edelman CM, Bernstain J, Barnett HL (1992) The nephrotic syndrome. In: Edelman CM Jr (ed) Pediatric kidney disease. Little Brown, Boston, pp 1247–1266Google Scholar
  8. 8.
    Gulati S, Sharma AP, Sharma RK, Gupta A, Gupta RK (2002) Do current recommendations for kidney biopsy in nephrotic syndrome need modifications? Pediatr Nephrol 17:404–408CrossRefPubMedGoogle Scholar
  9. 9.
    Mampso F, Gonzalo A, Teruel J, Losada M, GallegoN, Ortung J, Bellas C (1981) Mesangial deposit of IgM in patients with the nephrotic syndrome. Clin Nephrol 16:230–234PubMedGoogle Scholar
  10. 10.
    Trompeter RS (1989) Immunosuppressive therapy in the nephrotic syndrome in children. Pediatr Nephrol 3:194–200PubMedGoogle Scholar
  11. 11.
    Armitage P (1978) Statistical methods in medical investigations, 1st edn, (in Polish). PZWL, Warszawa, pp 97–103Google Scholar
  12. 12.
    National High Blood Pressure Education Program Working Group (1996) Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. Pediatrics 98:649–658PubMedGoogle Scholar
  13. 13.
    Wyszyńska T, Wieteska-Klimczak A (1998) Renal hypertension in children and adolescents. Pol Arch Med Wewn 100:188–195PubMedGoogle Scholar
  14. 14.
    Goldsmith DI, Novello AC (1992) Clinical and laboratory evaluation of renal function. In: Edelmann CM (ed) Pediatric kidney disease, 2nd edn. Little Brown, Boston, p 467Google Scholar
  15. 15.
    Schwarz A (2001) New aspects of the treatment of nephrotic syndrome. J Am Soc Nephrol 12:44–47CrossRefGoogle Scholar
  16. 16.
    Sibley RK, Manhan J, Mauer SM, Vernier RL (1985) A clinicopathologic study of forty-eight infants with nephrotic syndrome. Kidney Int 27:544–552PubMedGoogle Scholar
  17. 17.
    Martul EV, Cuesta MG, Churg I (1987) Histopathologic variability of the congenital nephrotic syndrome. Clin Nephrol 28:161–168PubMedGoogle Scholar
  18. 18.
    Opitz JM, Barnes EG (1992) Renal abnormalities in malformation syndromes. In: Edelman CM (ed) Pediatric kidney disease, 2nd edn. Little Brown, Boston, pp 1067–1120Google Scholar
  19. 19.
    Kissane JN (1983) Development of kidney. In: Heptinstall RH (ed) Pathology of kidney, 3rd edn. Little Brown, Boston, pp 61–82Google Scholar

Copyright information

© IPNA 2004

Authors and Affiliations

  • Danuta Ostalska-Nowicka
    • 1
  • Jacek Zachwieja
    • 1
  • Janusz Maciejewski
    • 1
  • Aldona Woźniak
    • 2
  • Wiesława Salwa-Żurawska
    • 2
  1. 1.Department of Pediatric Cardiology and NephrologyPoznan University of Medical SciencesPoland
  2. 2.Department of Clinical PathomorphologyPoznan University of Medical SciencesPoland

Personalised recommendations