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: 5.47). 09/2009; 124(2):747-57. DOI: 10.1542/peds.2008-1559
Source: PubMed


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.

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    • "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. "
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    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 · 2.70 Impact Factor
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    • "Children with nephrotic syndrome (NS) represent a unique patient population in pediatrics [1]. The signs and symptoms of NS include physical changes typified by edema that can be uncomfortable as well as alarming to patients and families. "
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    ABSTRACT: Nephrotic syndrome (NS) represents a common disease in pediatric nephrology typified by a relapsing and remitting course and characterized by the presence of edema that can significantly affect the health-related quality of life in children and adolescents. The PROMIS pediatric measures were constructed to be publically available, efficient, precise, and valid across a variety of diseases to assess patient reports of symptoms and quality of life. This study was designed to evaluate the ability of children and adolescents with NS to complete the PROMIS assessment via computer and to initiate validity assessments of the short forms and full item banks in pediatric NS. Successful measurement of patient reported outcomes will contribute to our understanding of the impact of NS on children and adolescents. This cross-sectional study included 151 children and adolescents 8-17 years old with NS from 16 participating institutions in North America. The children completed the PROMIS pediatric depression, anxiety, social-peer relationships, pain interference, fatigue, mobility and upper extremity functioning measures using a web-based interface. Responses were compared between patients experiencing active NS (n = 53) defined by the presence of edema and patients with inactive NS (n = 96) defined by the absence of edema. All 151 children and adolescents were successfully able to complete the PROMIS assessment via computer. As hypothesized, the children and adolescents with active NS were significantly different on 4 self-reported measures (anxiety, pain interference, fatigue, and mobility). Depression, peer relationships, and upper extremity functioning were not different between children with active vs. inactive NS. Multivariate analysis showed that the PROMIS instruments remained sensitive to NS disease activity after adjusting for demographic characteristics. Children and adolescents with NS were able to successfully complete the PROMIS instrument using a web-based interface. The computer based pediatric PROMIS measurement effectively discriminated between children and adolescents with active and inactive NS. The domain scores found in this study are consistent with previous reports investigating the health-related quality of life in children and adolescents with NS. This study establishes known-group validity and feasibility for PROMIS pediatric measures in children and adolescents with NS.
    Health and Quality of Life Outcomes 03/2013; 11(1):30. DOI:10.1186/1477-7525-11-30 · 2.12 Impact Factor
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    • "With regard to its etiology, nephrotic syndrome is recognized as idiopathic and secondary; idiopathic SN appears as a frequent pathology in pediatrics registering approximately 16 in 100,000 children under 18 years old 3 , approximately 50% of children affected are between the ages of 1 and 4 years, and 75% are less than 10 years of age 4 . The presentation outside of this age group requires the clinician to look for secondary causes of the etiology, including infectious causes such as parasites. "
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    ABSTRACT: Introduction: Although the association of infection by toxoplasmosis with the development of nephrotic syndrome is uncommon, cases of this association have nevertheless been reported in the literature for more than two decades, not only for congenital toxoplasmosis, but also in acquired cases, and occasionally in immunocompetent patients. Development: A case is presented of an immunocompetent patient aged 15 with clinical and laboratory indications of nephrotic/nephritic syndrome, in whom serological tests showed Toxoplasma infection. Conclusion: The presentation of nephrotic syndrome in ages where it is not commonly seen, leads to clinical suspicion of secondary causes. Active search for possible causes should include common tropical infections.
    Colombia Medica 07/2012; 43(3):226-229. · 0.36 Impact Factor
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