The increasing incidence of initial steroid resistance in childhood nephrotic syndrome.
BACKGROUND
Recently, a number of reports have highlighted changes in the histopathology and response to corticosteroid treatment in childhood nephrotic syndrome; however, these involved ethnically mixed populations. For comparison, the purpose of our research was to search for changes in the characteristics of nephrotic syndrome in a homogeneous population of Caucasian children over two consecutive decades.


METHODS
Chart analysis was performed to identify children with new-onset nephrotic syndrome. The children were admitted to the Division of Pediatric Nephrology, Zabrze, during two periods: 1986-1995 (76 patients) and 1996-2005 (102 patients). Specifically, a comparison of clinical characteristics and morphology of nephrotic syndrome between the two groups was performed. Steroid resistance was defined as no remission within 8 weeks of corticosteroid treatment. Histopathology was available in 36.8% and 43.1% of patients respectively.


RESULTS
There was a significant increase in primary steroid resistance in the latter decade: 15.8% vs 31.4% (P = 0.017). Changes in the histopathology did not reach the level of statistical significance: minimal change nephrotic syndrome 25% vs 9% (P = 0.095), mesangial proliferative glomerulonephritis 46.4% vs 61.3% (P = 0.21), focal segmental glomerulosclerosis 17.9% vs 20.4% (P = 0.78), membranoproliferative glomerulonephritis 7.1% vs 6.8% (P = 1.0), membranous glomerulonephritis 3.6% vs 0% (P = 0.39).


CONCLUSIONS
Our results show the increasing incidence of primary steroid resistance in childhood nephrotic syndrome.
Division of Pediatrics in Zabrze, Medical University of Silesia, Katowice, ul. 3 maja 13/15, 41-800, Zabrze, Poland. rhplus@op.pl
Beata
B
Banaszak
Paweł
P
Banaszak
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D017668:Age of Onset; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D015432:Glomerulonephritis, Membranoproliferative / Q000188:drug therapy / Q000453:epidemiology; D015433:Glomerulonephritis, Membranous / Q000188:drug therapy / Q000453:epidemiology; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D009402:Nephrosis, Lipoid / Q000188:drug therapy / Q000453:epidemiology; D009404:Nephrotic Syndrome / Q000151:congenital* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D011044:Poland / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors
D000305:Adrenal Cortex Hormones