RESEARCH ARTICLE


Clinical Patterns and Renal Survival of Nephrotic Syndrome in Childhood: A Single-Center Study (1980-2006)



Svitlana Fomina*, 1, Tatjana Pavlenko*, 2, Erling Englund3 , Ingretta Bagdasarova1
1 Department of Pediatrics, State Institution «Institute of Nephrology of the Academy of Medical Science of Ukraine», Kyiv, Ukraine
2 Department of Statistics, Stockholm University, Stockholm, Sweden
3 Västernorrland County Council, Research and Development Centre, Sundsvall, Sweden


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© Fomina et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to these authors at the (SF) State Institution «Institute of Nephrology of the Academy of Medical Science of Ukraine», Department of Pediatrics, 17b Degtyarivska str, Kiev, Ukraine; Tel/Fax: +38 044 2853644; E-mail:: sfomina@meta.ua, and (TP) Stockholm University, Department of Statistics, S-106 91 Stockholm, Sweden; Tel: +46 8 162578; Fax: +46 8 167511; E-mail: tatjana.pavlenko@stat.su.se


Abstract

To investigate changes in the diagnostic patterns, disease profiles courses and therapeutic strategies for severe forms of childhood nephrotic syndrome (NS), the clinical features of 1 349 children treated during two consecutive time periods, 1980-2000 (n=1 162) and 2001-2006 (n=187), were retrospectively reviewed. The significant increase in initial renal impairment, NS with hypertension, and NS with hypertension and hematuria was observed (27.7% vs 51.3%, 1.0% vs 5.3% and 16.4% vs 21.9%, respectively). The rate of both secondary steroid resistance (SR) and Focal Segmental Glomerulosclerosis increased significantly, (1.8% vs 5.6%, p=0.032, and 14.9% vs 29.0%, p=0.034, respectively). The initial renal insufficiency and hypertension were highly predictive of the development of stage 3 of chronic kidney disease (CKD3) among SR patients in a multivariate Cox regression (p=0.001) for years 1980-2000. A higher hazard of CKD3 in male SR patients from three to six years old was observed in 2001-2006. Kaplan-Meier survival curves revealed a shift in the cumulative probability of CKD3, indicating a slower decline of the renal function for SR NS in the years 2001-2006 (p=0.008): the estimated five-year CKD3 risk was 39.7% vs 27.7%. Achievements in inducing remission and retarding the development of CKD3 in combination with increased severity of NS indicate the effectiveness of domestic strategies of NS management.

Keywords: : Nephrotic syndrome, child, pathology, outcome, renal survival..