Management of Childhood Onset Nephrotic Syndrome

Division of Nephrology and Hypertension, Department ofMedicine and Pediatrics, University of North Carolina, ChapelHill, North Carolina 27599-7155, USA.
PEDIATRICS (Impact Factor: 5.3). 09/2009; 124(2):747-57. DOI: 10.1542/peds.2008-1559
Source: PubMed

ABSTRACT The therapeutic approach to childhood nephrotic syndrome is based on a series of studies that began with an international collaborative effort sponsored by the International Study of Kidney Disease in Children in 1967. The characteristics of children presenting with nephrotic syndrome have changed over recent decades with greater frequency of the challenging condition focal segmental glomerulosclerosis and a greater prevalence of obesity and diabetes mellitus, which may be resistant to glucocorticoids in the former and exacerbated by long-term glucocorticoid therapy in the latter 2 conditions. The Children's Nephrotic Syndrome Consensus Conference was formed to systematically review the published literature and generate a children's primary nephrotic syndrome guideline for use in educational, therapeutic, and research venues.

  • Source
    • "Forty nephropathy rats were randomly divided into untreated nephropathy model group (Group B), asiaticoside groups (Groups C, D, and E, n = 8, respectively) and a positive control group (Group F, n = 8). Prednisone was used as a positive control (Gipson et al., 2009). From the 4th week on, Groups A and B were administered saline; Groups C, D, and E were administered 8 mg/kg, 16 mg/kg, and 32 mg/kg asiaticoside (Zhang et al., 2007), respectively; Group F was administered 25 mg/kg prednisone. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Centella asiatica has been used to treat kidney diseases in Chinese traditional medicine. Asiaticoside (an extraction of centella asiatica) exerts a variety of pharmacological effects including immunomodulatory and anti-inflammatory functions. However, the mechanism of asiaticoside in the treatment of renal diseases remains largely unknown. This study investigated the molecular mechanism of asiaticoside in treating adriamycin-induced nephropathy of rats. Sixty-two SD male rats were randomly divided into normal control group (n=12) and nephropathy group (n=50). Except for the normal control group, rats were injected with adriamycin (6mg/kg) via the tail vein to induce nephropathy. Adriamycin induced nephropathic rats were divided into untreated group, prednisone group (25mg/kg), and asiaticoside groups with various dosages (8, 16 and 32mg/kg). Samples of urine and serum, tissue of kidney were collected for analysis after treatments for four weeks. Morphological changes were evaluated under light microscope and electron microscope. Synaptopodin, desmin, nephrin and podocin mRNA and protein were determined by RT-PCR and Western blotting. Compared to the untreated nephropathy group, asiaticoside treatment mitigated histological damages, decreased 24-hour urine protein excretion and total cholesterol, increased serum albumin. Asiaticoside treatment reduced the mRNA and protein levels of synaptopodin, nephrin and podocin in a dose-dependent manner. Furthermore, asiaticoside treatment increased the mRNA and protein levels of desmin. Asiaticoside can mitigate adriamycin-induced nephropathy in rats, this is associated with the increase in synaptopodin, nephrin and podocin gene expression, and the decrease in desmin gene expression.
    Life sciences 07/2013; 93(8). DOI:10.1016/j.lfs.2013.07.010 · 2.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Das nephrotische Syndrom ist durch große Proteinurie sowie Hypalbuminämie definiert und stellt eine der häufigsten Nierenerkrankungen im Kindesalter dar. Die Unterteilung erfolgt nach den Kriterien: Ätiologie, Alter bei Erstmanifestation, Ansprechen auf Glukokortikoidgabe und histologische Befunde. Nach den Ursachen lässt sich das häufigere primäre nephrotische Syndrom von symptomatischen (sekundären) Formen im Rahmen anderer Grunderkrankungen abgrenzen. Sehr selten ist das kongenitale nephrotische Syndrom, das meist genetisch bedingt ist. Klinisch und prognostisch relevant ist in erster Linie das Ansprechen auf eine Glukokortikoidtherapie. Die primäre Steroidresistenz betrifft ca. 10% der Patienten mit idiopathischem nephrotischem Syndrom. Histologisch findet sich dann meist eine fokal-segmentale Glomerulosklerose, wohingegen bei steroidsensiblem nephrotischem Syndrom histologisch fast immer eine „Minimal-change“-Glomerulonephritis nachzuweisen ist. Im Fall häufiger Rezidive oder einer Steroidabhängigkeit sind zur Vermeidung von steroidassoziierten Nebenwirkungen alternative immunsuppressive Therapien z. B. mit Alkylanzien, Kalzineurininhibitoren oder Mykophenolsäure zu erwägen.
    Monatsschrift Kinderheilkunde 08/2012; 160(8). DOI:10.1007/s00112-012-2713-6 · 0.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The pathophysiologic mechanism of nephrotic syndrome is not yet known clearly. At least in some cases, certain 'circulating factors' are thought to increase the glomerular protein permeability. Considering the systemic effect of the circulating factor on peritoneal membrane, we evaluated the loss of protein through peritoneal membrane in patients on peritoneal dialysis due to the end stage renal disease (ESRD) caused by steroid resistant nephrotic syndrome (SRNS).
    Journal of the Korean Society of Pediatric Nephrology 01/2009; 13(2). DOI:10.3339/jkspn.2009.13.2.189
Show more