NEPHROTIC SYNDROME

Abstract

Objective: (1) To find out relapse rate in our nephrotic patients. (2) To
assess the frequency of steroid dependent and steroid resistant nephrotic syndrome case. (3) To find out diagnostic
value of single sample urine protein and creatinine ratio. (4) To study the complications of therapy Design: Prospective,
cohort, open clinical study. Setting: Pediatrics Medicine Department Nishtar Hospital, Multan through outdoor or
emergency. Period: From June 1997 to May 1998. Material and methods: Complaint of peri-orbital or generalized
edema, haematuria, oliguria, azotemia, hypertension and proteinuria on urine examination. Results: 4050 patients were
admitted during study period, only 50 patients were diagnosed nephrotic syndrome. Incidence was 1 in 8 (0.8%), male
to female ratio was nearly 2:1, and generalized edema was major clinical presentation. Most of the patients had normal
renal function and had no hypertension. Maximum 39(78%) patients had responded to steroids within 4 weeks of
therapy, 47 (94%) patients responded to steroids but only 20(40%) remained in remission, other 21(42%) patients
showed relapse, 3(6%) were steroid resistant and 6(12%) were steroid dependent. Out of 4(8%), 3(6%) patients gave
response to cyclophosamide. Cushingoid features, elevated blood pressure, abdominal discomfort were common
complications to steroids. Single voided urine sample protein to creatinine ratio had equal significance as had 24 hours
urinary protein in diagnosis of nephrotic syndrome in children. Prognosis of this disease is good despite the recurrence
that takes place and the prolonged duration of treatment. Conclusion: We can currently depend on single morning
voided urinary protein to creatinine ratio as compared to 24 hours urinary protein, to save the time and money. Along
with low dose steroid, liberal intake of fluids before and during cyclophosphamide therapy can reduce the risk of
haemorrhagic cystitis.