Abstract
Ethnicity and age play important roles in the epidemiology of idiopathic nephrotic syndrome (INS) in children. The purposes of this study were to compare the clinical features, renal histopathology, steroid response, and long-term prognosis in Chinese children between different age groups. This is a retrospective cohort study of children aged between 2 and 18 years old with INS. Patients were divided into two groups according to age. Group I consisted of children between 2 and 8 years old (n = 49). Group II consisted of the remaining patients (n = 50). The clinical biochemical parameters, response to steroid treatment, renal histology, and long-term outcomes were analyzed. The biochemical parameters at the onset were similar in the two groups. Group II had a significantly higher frequency of microscopic hematuria (P = 0.011). Of the 67 children biopsied, minimal change disease was the most common histopathology for both groups. There was a higher frequency with focal and segmental glomerulosclerosis in group II (24% vs. 6.1%), but the difference between the two groups was not significant. During follow-up, the frequency of hypertension was significantly higher in group II (P = 0.006). Two cases in group I developed chronic kidney disease (CKD) vs. eight cases in group II. The frequency of progression to CKD is significantly higher (P = 0.042) in Group II. In conclusion, children beyond 8 years of age with INS have a higher incidence of microscopic hematuria, higher risk of hypertension and progression to CKD in long-term follow-up.
Similar content being viewed by others
References
Ahmad H, Tejani A (2000) Predictive value of repeat renal biopsies in children with nephrotic syndrome. Nephron 84:342–346, doi:10.1159/000045609
Andenmatten F, Bianchetti MG, Gerber HA et al (1995) Outcome in idiopathic childhood nephrotic syndrome. Scand J Urol Nephrol 29:15–19
Baqi N, Singh A, Balachandra S et al (1998) The paucity of minimal change disease in adolescent with primary nephrotic syndrome. Pediatr Nephrol 2:105–107, doi:10.1007/s004670050414
Border WA (1988) Distinguishing minimal-change disease from mesangial disorders. Kidney Int 34:19–34, doi:10.1038/ki.1988.197
Borges FF, Shiraichi L, da Silva MP et al (2007) Is focal segmental glomerulosclerosis increasing in patients with nephrotic syndrome. Pediatr Nephrol 22:1309–1313, doi:10.1007/s00467-007-0516-0
Eddy AA, Symons JM (2003) Nephrotic syndrome in childhood. Lancet 362:629–639, doi:10.1016/S0140-6736(03)14184-0
Gulati S, Kher V, Gupta A et al (1995) Spectrum of infections in Indian children with nephrotic syndrome. Pediatr Nephrol 9:431–434, doi:10.1007/BF00866719
Gulati S, Sural S, Sharma RK et al (2001) Spectrum of adolescent-onset nephrotic syndrome in Indian children. Pediatr Nephrol 16:1045–1048, doi:10.1007/s004670100023
Hauser RA, Lacey DM, Knight MR (1988) Hypertensive encephalopathy: magnetic resonance imaging demonstration of reversible cortical and white matter lesions. Arch Neurol 45:1078–1083
Hsu HC, Chen WY, Lin GJ et al (1984) Clinical and immunopathologic study of mesangial IgM nephropathy: report of 41 cases. Histopathology 8:435–466, doi:10.1111/j.1365-2559.1984.tb02355.x
Inguilli E, Tejani A (1991) Racial differences in the incidence and renal outcome of idiopathic focal segmental glomerulosclerosis in children. Pediatr Nephrol 5:393–397, doi:10.1007/BF01453661
International Study of Kidney Disease in Children (1978) Nephrotic syndrome in children: perdition of histopathology from clinical and laboratory characteristics at time of diagnosis. A report of the International Study of Kidney Disease in children. Kidney Int 13:159–165, doi:10.1038/ki.1978.23
Joh K, Matsuyama N, Kanetsuna Y et al (1998) Nephrotic syndrome associated with diffuse mesangial hypercellularity: is it a heterogeneous disease entity. Am J Nephrol 18:214–220, doi:10.1159/000013339
Kumar J, Gulati S, Sharma AP et al (2003) Histopathological spectrum of childhood nephrotic syndrome in Indian children. Pediatr Nephrol 18:657–660
Martinelli R, Okumura AS, Pereira LJ, Rocha H (2001) Primary focal segmental glomerulosclerosis in children: prognosis factors. Pediatr Nephrol 16:658–661, doi:10.1007/s004670100639
Meyrier A (2004) Nephrotic focal segmental glomerulosclerosis in 2004: an update. Nephrol Dial Transplant 19:2437–2444, doi:10.1093/ndt/gfh320
Myllymäki J, Saha H, Mustonen J et al (2003) IgM nephropathy: clinical picture and long-term prognosis. Am J Kidney Dis 41:343–350, doi:10.1053/ajkd.2003.50042
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576, doi:0.1542/peds.114.2.S2.555
Onder AM, Lopez R, Teomete U et al (2007) Posterior reversible encephalopathy syndrome in the pediatric renal population. Pediatr Nephrol 11:1921–1929, doi:10.1007/s00467-007-0578-z
Soeiro EM, Koch VH, Fujimura MD, Okay Y (2004) Influence of nephrotic state on the infectious profile in childhood idiopathic nephrotic syndrome. Rev Hosp Clin Fac Med Sao Paulo 59:273–278, doi:10.1590/S0041-87812004000500009
Srivastava T, Simon SD, Alon US (1999) High incidence of focal segmental glomerulosclerosis in nephrotic syndrome of childhood. Pediatr Nephrol 13:159–165
Tarshish P, Bernstein J, Tobin J, Edelmann CM Jr et al (1993) Course of minimal change nephrotic syndrome (MCNS). A report of the International Study of Kidney Disease in Children. J Am Soc Nephrol 4:288 (abstract)
Tejani A, Nicastri AD, Sen D et al (1983) Long-term evaluation of children with nephrotic syndrome and focal segmental glomerulonephritis. Nephron 35:225–231
Wang SS, Tsau YK, Lu FL, Chen CH (2000) Hypovolemia and hypovolemic shock in children with nephrotic syndrome. Acta Paediatr Taiwan 41:179–183
Wehrmann M, Bohle A, Held H et al (1990) Long-term prognosis of focal sclerosis glomerulonephritis.An analysis of 250 cases with particular regard to tubulointerstitial changes. Clin Nephrol 33:115–122
White RHR, Glasgow EF, Mills RJ (1970) Clinicopathological study of nephrotic syndrome in childhood. Lancet 1:1353–1359, doi:10.1016/S0140-6736(70)91268-7
Wong W (2007) Idiopathic nephrotic syndrome in New Zealand children, demographic, clinical feature, initial management and outcome after twelve-month follow up: results of a three-year national surveillance study. J Paediatr Child Health 43:337–341, doi:10.1111/j.1440-1754.2007.01077.x
Zaffanello M, Franchini M (2007) Thromboembolism in childhood nephrotic syndrome: a rare but serious complication. Hematology 12:69–73, doi:10.1080/10245330600940048
Zeis PM, Kavazarakis E, Nakopoulou L et al (2001) Glomerulopathy with mesangial IgM deposits: long-term follow up of 64 children. Pediatr Int 43:287–292, doi:10.1046/j.1442-200x.2001.01396.x
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Chang, JW., Tsai, HL., Wang, HH. et al. Clinicopathological features and prognosis of Chinese children with idiopathic nephrotic syndrome between different age groups. Eur J Pediatr 168, 1189–1194 (2009). https://doi.org/10.1007/s00431-008-0902-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-008-0902-z