Abstract 1994
Background: Transient diminished creatinine clearances were reported in 30% of patients with idiopathic nephrotic syndrome in the ISKDC study. Objective: This study was performed to (1) identify risk factors for the development of acute renal insufficiency during relapse of nephrotic syndrome and (2) to see if the presence of acute renal insufficiency predicts progression to ESRD. Material and Methods: Retrospective chart review of patients was done to identify children with idiopathic nephrotic syndrome from 1991-1998. The patients were divided into two groups, those with normal renal function at the time of relapse and those who developed renal insufficiency (defined as rise in creatinine greater than 50% from baseline). Age at onset of the nephrotic syndrome, sex, histopathologic lesion, use of medications such as diuretics, steroids, cyclosporine, and ACE inhibitors, serum cholesterol and serum albumin levels and amount of proteinuria were analyzed to identify risk factors for the development of renal insufficiency. The statistical analyses were done using Fisher's Exact test and Pearson Chi- Square test. Results: Total of 67 patients with idiopathic nephrotic syndrome was identified, of which 24 (35.8%) were noted to have renal insufficiency at the time of relapse. Patients who initially had diagnosis of MCNS and later developed FSGS showed statistically increased incidence of renal insufficiency at the time of relapse (P <. 013). We also found that children who were hypertensive and/or were on cyclosporine, prednisone and diuretics prior to the development of nephrosis were at an increased risk for development of renal insufficiency (P <. 05, p<. 004, p<. 014 and p<. 027 respectively). However, the development of renal insufficiency did not correlate with the progression to ESRD. Age at onset of the nephrotic syndrome, sex, s.cholesterol and s.albumin levels and the use of ACE inhibitors were not predictors for renal insufficiency during relapse. Conclusions: We conclude that (1) a subgroup of children who presented with MCNS and on repeat biopsy progressed to FSGS have increased risk for developing renal insufficiency and that (2) the presence of hypertension and the use of cyclosporine, prednisone and diuretics prior to relapse also increases the risk of renal insufficiency during relapse of nephrotic syndrome.
