Causes of Relapses in Primary Nephrotic Syndrome in children

Background: About 80% of children with primary nephrotic syndrome (PNS) relapse. Nevertheless they recover without impaired renal function. Among the most common causes include infections: pneumonia, upper airways infection, urinary tract infection.

Objective: Identifying the causes of relapses in cases of PNS and its clinical, biological, therapeutic and evolutive profile. Methods. The analysis of the Pediatric Clinic Sibiu hospitalized cases with PNS in the last 10 years.

Inclusion criteria: children diagnosed with PNS and admitted for relapses, or intercurrent problems, or clinic and biologic assess.

Results: Were recorded 142 admittances: 47 relapses (A group of study) and 95 without relapses (B group of study/control group). Pneumonia was the most common cause (23,41 %) of PNS relapses (p 0,05). In control group, upper airways infection was the most frecquent intercurrence (21,05 %), without any significance (p 0,26). The weight over 90th percentile and blood pressure (BP) were similar on both groups (OR = 2,2 [95% CI 0,55-8,74]; p 0,21). The highest value of proteinuria was found on the second repalse, with decreasing values as the order of relapse increases. We found an extremely difference of serum proteins, albumin, cholesterol between groups (p 0,00**). The relapses have been occurred: in absence of prednison (22 cases), in continued period of prednison cure (10 cases), in discontinued period of prednison cure (13 cases), in presence of medrol (2 cases). In presence of pneumonia, the most affected parameters were BP, cholesterol and triglycerides (p 0,006).

Conclusions: The clinical and biological parameters considered optional in the definition of PNS in children – blood pressure, cholesterol and triglycerides, must be managed throughout the evolution of PNS. Their presence is essential for PNS diagnosis and prediction of evolution.