[Evaluation of therapeutic strategies in congenital nephrotic syndrome of the Finnish type].
BACKGROUND
Congenital nephrotic syndrome of the Finnish type (CNFS) is caused by mutations in the nephrin gene. This disease manifests as massive proteinuria, gross peripheral edema, and ascites during the first weeks of life. In the last few years the prognosis has improved due to new treatment strategies: antiproteinuria drugs, intensive nutrition, nephrectomy, dialysis, and renal transplantation. The aim of this study was to determine the impact of these therapeutic measures.


METHODS
We performed a descriptive retrospective epidemiological study of 12 patients diagnosed with CNSF between January 1985 and August 2005. We included patients aged less than 14 years old with massive proteinuria and generalized edema during the neonatal period, a large placenta (> 25 % of birth weight), and normal glomerular filtration rate during the first 6 months of life, in whom other causes of congenital nephrotic syndrome were ruled out.


RESULTS
The diagnosis was established after a median period of 17 days (range 6-30). The most commonly used treatments were albumin infusions (91.7 %), angiotensin-converting enzyme inhibitors (66.7 %), and indomethacin (58.3 %). Dialysis was started in 58.3 %, at a median age of 3.76 years (2.81-7.6). The main complication was acute peritonitis (85.7 %). Renal transplantation was performed in 58.3 % of the patients; of these, 71.4 % have normal renal function after a median follow-up of 3.73 years (0.8-6.3). The median plasma albumin level during the pretransplant period was 0.17 g/dL (0.12-0.28). Plasma cholesterol and triglyceride levels decreased significantly after renal transplantation (p = 0.043). Fifty percent of the patients achieved adequate height and weight for their age and gender. Mortality was 33.3 %.


CONCLUSIONS
Antiproteinuria drugs and intensive nutritional therapy improve clinical control and delay the start of dialysis and renal transplantation, increasing the probability of success.
Canalejo González
D
D
Unidad de Nefrología Pediátrica, Hospitales Universitarios Virgen del Rocío, Sevilla, España. davidcanalejo@gmail.com
González Rodríguez
J D
JD
Navas López
V M
VM
Sánchez-Moreno
A
A
Fijo López-Viota
J
J
Martín-Govantes
J
J
D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009404:Nephrotic Syndrome / Q000145:classification / Q000151:congenital* / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies