Abstract
Background and Aims
Nephrotic syndrome not responding to steroids (corticodependent, corticorresistant, frequent relapses) in children is a disease with significant morbidity and mortality. The evolution to chronic kidney disease has a relationship with time to histopathological diagnosis, the treatment performed, its duration, the early identification of risk factors being of utmost importance.
Method
An observational-retrospective study was carried out with transverse temporality, the universe of study was patients with a diagnosis of nephrotic syndrome from 2007 to 2017 with outcome to chronic kidney disease, information was obtained from the clinical files and their subsequent Bivariate analysis of qualitative variables with linear Chi and quantitative variables of normal distribution with ANOVA and abnormal distribution with Kruskas Wails.
Results
The clinical and biochemical differences of 121 patients with a diagnosis of non-steroidal nephrotic syndrome were determined. The clinical presentation of corticorresistant was the most frequent in 89 (73.6%), corticodependents 16 (13.2%) and frequent relapses 16 (13.2%), being the association with the major histopathological type of corticorresistant with GEFS 60 (83.3% ), mesangial proliferation 13 (61.9%) and minimum changes 9 (60%) with a p 0.05. The sex that was determined most frequently were men 83 (68.6%), women 38 (31.4%) p 0.8. The age at diagnosis had a frequency of 60 (49.6%) between 2.1 to 10 years of age and 60 (49.6%) in those over 10.1 years of age p 0.7. The evolution to chronic kidney disease was determined in 27 (22.3%), being greater its relationship with GEFS 21 (29.2%), diffuse mesangial proliferation 2 (9.5%), minimum changes 1 (6.7%) p 0.05. The time of evolution to chronic kidney disease between 0 and 3 years was 20 (16.5%), between 4 and 7 years was 4 (3.3%), and greater than 7 years 3 (2.5%), finding a greater relationship with GEFS between the 0 to 3 years that were 15 (20.8%) p 0.1. It was determined that the type of treatment most commonly used were anticalcineurinics (Cyclosporine-Tacrolimus), cyclosporine in 51 (42.1%), tacrolimus in 54 (44.6%), mycophenolate 10 (8.3%), and without treatment 6 (5% ) with a higher GEFS ratio of the use of cyclosporine 32 (44.4%) and tacrolimus 32 (44.4%) p.0.017. The use of ACEI and ARA II as antiproteinurics determined only ACEI in 8 (6.6%), ARA II 9 (7.4%) and IECA + ARA II in 52 (43%), none in 52 (43%), with a ratio of use of ACEI + ARA II in patients with GEFS in 35 (48.6%) p 0.5.
Conclusion
In this study, similar results were found in frequency of age, sex, progression to chronic kidney disease, histopathological type, treatment with anticalcineurinics and use of antiproteinurics in patients with nephrotic syndrome not responding to steroids to those reported in the literature, being the first in Mexico should be the beginning of different cohorts (response, duration of treatment, complications of the disease) in this type of patients.
HDL abnormalities in nephrotic syndrome and chronic kidney disease
