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Patients With Idiopathic Nephrotic Syndrome Essay

1834 words - 7 pages

Introduction

It is known that glucocorticoids (GCs) therapy is the treatment of choice for patients with idiopathic nephrotic syndrome (INS); however some patients fail to respond to the treatment even when given high-dose GCs. For those patients, the treatment should be bolstered by synergising GCs with other immunosuppressant [1].
Although biochemical alterations and clinical manifestations in most nephrotic patients seem to be quite similar, substantial differences are encountered regarding the course of disease. Relapses of proteinuria are experienced in approximately 60% to 80% of steroid-sensitive nephrotic syndrome patients and despite initial complete remission some remain steroid dependent or become steroid-resistant [2].
The lack of response to corticosteroids has been explained by several mechanisms. This may be ascribed to overwhelming disease severity, poor compliance, abnormalities in glucocorticoid metabolism or poor absorption, especially in patients with NS, who often develop heavy proteinuria and Hypoalbuminaemia, and, finally, by GCs resistance due to a GCR or postreceptor abnormality. GCR was incriminated in worsening the response to steroids earlier [3,4], but inadequate response to these agents, either due to inherited target tissue defective response or acquired impaired responsiveness is often reported by the clinicians in a number of patients [5].
If clinical response was predicted before therapy, synergised treatment might be performed at the beginning of the treatment to avoid side effects of chronic high-dose hormone therapy, which could improve the individual response to GC therapy and benefit more patients. Glucocorticoid receptor (GCR) seems to be related to the pathogenesis of steroid resistance [6].
Thus, we hypothesized that detection of GCR expression by a suitable method before treatment might be beneficial to predict steroid response.
To investigate whether steroid responsiveness is dependent on the amount of T lymphocytes (CD3+) expression of GCR, we compared the expression of GCR by lymphocytes obtained from MCD patients according to the response to glucocorticoids. Further, we analyzed the correlations between the time interval from the start of glucocorticoid therapy to complete remission (CR) and the of T lymphocytes (CD3+) expression of GCR.

Patients and methods:

This case control study was conducted in the nephrology unit in Madinah Maternity and Children Hospital (MMCH) from February 2009-Junuary 2011. During this period 60 children in the age group 2-10 years with new-onset steroid sensitive nephrotic syndrome (SSNS) were prospectively studied at presentation and without knowledge of their subsequent steroid responsiveness. Nephrotic syndrome was defined as the presence of edema, proteinuria of at least 2.0 g/24 hours or urine protein: creatinine ratio of at least 2.0 and hypoalbuminemia (<2.0 g/dL). Steroid...

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