Can Steroid Response in Idiopathic Childhood Nephrotic Syndrome be Predicted? A Single Center Quasi-Experimental Study

  • Madeeha Rehman Sindh Institute of Urology and Transplantation, Karachi Pakistan
  • Ali Asghar Sindh Institute of Urology and Transplantation, Karachi Pakistan
  • Afshan Ehsan Sindh Institute of Urology and Transplantation, Karachi Pakistan
  • Madiha Aziz Sindh Institute of Urology and Transplantation, Karachi Pakistan
  • Sabeeta Khatri Sindh Institute of Urology and Transplantation, Karachi Pakistan
  • Seema Hashmi Sindh Institute of Urology and Transplantation, Karachi Pakistan
Keywords: Biomarkers, β2-microglobulin, Idiopathic childhood nephrotic syndrome, Proteinuria, Steroid-resistant nephrotic syndrome

Abstract

Objective: To predict the role of clinical risk factors and urinary β2-microglobulin levels as a biomarker for steroid-resistant nephrotic syndrome.

Study Design: Quasi-experimental study.

Place and Duration of Study: Paediatric Nephrology Department, Sindh Institute of Urology and Transplantation, Karachi Pakistan, from Jun 2019 to Nov 2020.

Methodology: All children (3 months to 12 years) with either first episode or relapse of the nephrotic syndrome were included. A stored urine sample was used on 100 patients with steroid-sensitive (group-1) and 35 patients with steroid-resistant nephrotic syndrome (group-2). In addition, histopathology of all patients with steroid-resistant nephrotic syndrome was recorded.

Results: Both groups and those who had focal segmental glomerulosclerosis were compared and analysed to evaluate the predictability of steroid response. There was a significant association in both groups for microscopic haematuria, hypertension, heavy proteinuria (urine spot protein to creatinine ratio >10 g/g) and increased β2-microglobulin levels (> 3× normal) as individual risk factors (p<0.01). The sensitivity of β2-microglobulin levels was 78% and a positive predictive value of 80%. Multivariate regression analysis on steroid-resistant nephrotic syndrome as a group did not confer a higher risk; however, for children with focal segmental glomerulosclerosis, the likelihood of steroid unresponsiveness was significantly higher for the same parameters.

Conclusion: The addition of biomarker measurement and known clinical risk factors helped predict steroid-resistant focal segmental glomerulosclerosis. However, further studies are warranted before these results can be generalized.

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Author Biographies

Madeeha Rehman, Sindh Institute of Urology and Transplantation, Karachi Pakistan

Fellow, Department of Pedatric Nephrology

Madiha Aziz, Sindh Institute of Urology and Transplantation, Karachi Pakistan

Assistant Professor, Department of Pediatric Nephrology

Sabeeta Khatri, Sindh Institute of Urology and Transplantation, Karachi Pakistan

Assistant Professor , Department of Pediatric Nephrology

Published
2022-06-26
How to Cite
Rehman, M., Asghar, A., Ehsan, A., Aziz, M., Khatri, S., & Hashmi, S. (2022). Can Steroid Response in Idiopathic Childhood Nephrotic Syndrome be Predicted? A Single Center Quasi-Experimental Study. PAFMJ, 72(3), 980-85. https://doi.org/10.51253/pafmj.v72i3.6346
Section
Original Articles