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Article
Trends of Histopathology in Childhood Nephrotic Syndrom

Author: Taghreed Fadel Mohammed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 1 Pages: 47-55
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Nephrotic syndrome (N.S.) is clinical manifestation of different histopathological subtypesOBJECTIVE:This study was conducted to analyze the trend of histopathological subtypes in idiopathic nephrotic syndrome.METHODS:A prospective study was performed from January 2004 to May 2005, at Central child teaching hospital and Al-karama teaching hospital involving 113 patients aged up to 18 years with nephrotic syndrome. The following parameters were studied (age, gender, initial episode, relapse, predisposing factors, positive family history of nephrotic syndrome, clinical presentation and investigation, treatment and complication).RESULT:One hundred thirteen patients enrolled in this study, 71(63%) were males and 42(37%) were females, male to female ratio was 1.7/1. 23(20.3%) patients were with initial attack of nephrotic syndrome, while 90(79.6%) patients with relapse. Age at onset ranged between 0.7-14 (median 2.3) years. Family history of nephrotic syndrome was found in 8 (7%) patients. Biopsies was done in 74(65%) patients. 36(48.6%) patients showed focal segmental glomerulosclerosis. 17(22.9%) patients showed minimal change disease.10(13.5%) patients showed membranoproleferative glomerulonephritis. Other histopathological sub types were 6(8%) patients with mesangioproleferative glomerulonephritis, 3(4%) patients with global masengial sclerosis, and 2 (2.7%) patients with amyloidosis.CONCLUSION:This trend of histopathologic patterns has profound prognostic significance and has significant implications in the management of childhood nephrotic syndrome. There is shift toward an increasing incidence of focal segmental glomerulosclerosis and to lesser extent, the membranoproleferative glomerulonephritis in Iraqi children presenting with idiopathic nephrotic syndrome. Our finding is in agreement with the recommendation of performing renal biopsies on children with idiopathic nephrotic syndrome who are steroid dependant in addition to those who are steroid resistant particularly before starting cytotoxic medication.


Article
Growth Delay in Steroid Sensitive Nephrotic Patients

Authors: Salim Zyara Abdullah --- Faris Matti Frankul --- Asaad Abdullah Abbas --- Shatha Hussein Ali --- et al.
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2007 Volume: 6 Issue: 2 Pages: 129-135
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Growth in patients with idiopathic nephrotic syndrome (INS) is influenced by several factors, they suffer the influence of the disease itself as long as there is proteinuria, caused by the increase of the glomerular permeability and leading to hypoproteinemia. The effects of the glucocorticoid treatment, which alters growth by a direct action on the growth cartilage, or via disturbances of growth factors. In this study we assess the effect of nephrotic syndrome, it's relapse rate and it's treatment (i.e. steroid), in the statural growth of steroid sensitive nephrotic patients.METHODS:A Prospective study of 110 steroid responsive nephrotic patients collected from AL- Kadhemia Teaching Hospital, Central Child Teaching Hospital, Child Wellfaire Teaching Hospital & AL-Karama Teaching Hospital. The study started from first of June 2005 to first of June 2006. Data collected as following: age, sex, date of first diagnosis, duration of disease, number of relapses per year, measurement of the height, weight and body mass index and sign of steroid toxicity.RESULTS:Total number of our patients were 110, 74(67.3%) were males and 36(32.7%) were females, with male to female ratio of 2:1. The age of our patients range from 2-18 years with a mean of 7.9+3.8 years.Thirty-one (28.2%) of them were with height below 3rd percentile for their age, 24(77.4%) were males and 7(22.6%) were females.Twenty- five (22.7%) patients were at pubertal age. Eighteen (72%) were males and 7(28%) were females, and 17(68%) of them have height below 3rd percentile.Seventy –six (69%) patients have their onset of the disease at age between 2 and 6 years. Forty-six (41.8%) of patients have disease duration of less than 3 years, 3 (6.5%) of them were have height below 3rd percentile, 46(41.8%) with duration of 3-6years, 14(30.4%) them were have height below 3rd percentile and 18(16.4%) with duration of more than 6 years, 14(77.8%) of them have height below 3rd percentile.Fifty-five (50%) patients had frequent relapses, twenty-seven (49.1%) of them have height below 3rd percentile, compared to 4(7.3%) of those with infrequent relapse had height below 3rd percentile.Forty-seven (42.7%) patients show sign of steroid toxicity(cushigoid facial appearance with or with out hypertention,obesity,hirsutism..etc) 25(53.2%) of them have height below 3rd percentile, compared to 6(9.5%) of those who have no sign of toxicity.CONCLUSSION:Nephrotic syndrome is a potentially chronic disease with patients suffering a relapsing course and being at risk of frequent courses of prednisolone therapy with increase the risk of growth delay especially in patients reaching pubertal age and still taking steroid therapy.

Keywords

Growth Delay --- Steroid --- Nephrotic.


Article
Childhood nephritic syndrome Clinical manifestations and histopathlogical spectrum

Author: Nariman-F. -Ahmed FICMS Raghad Ibrahim FICMS د. نريمان فهمي احمد
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2007 Volume: 49 Issue: 3 Pages: 304-306
Publisher: Baghdad University جامعة بغداد

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Background: Nephrotic syndrome in children is a clinical manifestation of different histopathological subtypes.Objectives: The objectives were to study the different histopathological subtypes of idiopathic nephrotic syndrome and to study their clinical and biochemical parameters at the time of diagnosis for children admitted to Children Welfare Teaching Hospital.Methods: A Retrospective study M’as done on 160 children with idiopathic nephrotic syndrome who were diagnosed and/or treated at Children Welfare Teaching Hospital and were followed up in the pediatric nephrology consultation clinic betM'een April 2004 and April 2006.Results: The study group included 40 children with idiopathic nephrotic syndrome r Who underwent renal biopsy. There were 26(68.7%) males and 14(31.2%) females.Age at onset ranged between (1-15) years, median age (3.5) years. Facial oedema M’as fcnmd in 90%, hypertension in 45% patients, gross hematuria in 27.5 and persistent microhematuria in 45%. Sixteen (40%) patients had focal and segmental glomemlosclerosis on renal biopsy, nine (22.5%) patients minimal change nephrotic syndrome, eight (20%) patients mesangioproliferative glomerulonephritis, and seven (17.5%) patients had membranoproliferative glomerulonephritis.Conclusion: Focal and segmental glomemlosclerosis was the most common histopathological subtype in our study group. Further large studies is needed to find out changing trends of histopathology in childhood nephrotic syndromeKey words: Nephrotic syndrome, Children, Histopahological subtypes


Article
Treatment of Steroid Resistant Nephrotic Syndrome
علاج التناذر الكلوي المقاوم للستيرويد

Author: Abdul-Kareem M. Ali د.عبد الكريم محمد علي
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2009 Volume: 22 Issue: 3 Pages: 197-200
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background: The therapy of nephrotic syndrome with steroid resistance is still a matter of controversy. Optimal therapy for glucocorticoid-resistance MCD is not well defined. A prospective study was done on children who attained Tikrit Teaching Hospital and Beji General Hospital during the period from 1st of July 2004 to the end of July 2006.Objective: To find out the benefit of immunosuppressive therapy (IV methylprednisolone followed by oral prednisolone therapy for one year along with six doses of monthly pulses of cyclophosphamide) for children with steroid resistant nephrotic syndrome. Patients & Methods: Thirty-four children with steroid resistant nephrotic syndrome were treated with above regime. The remission of the disease was determined at the end of first and second year. Results: The above protocol could induce and maintain remission in 81.8% (9/11) of children with minimal change nephrotic syndrome, 66.7% (6/9) of children with diffuse mesangial proliferation and in only 16.7% (1/6) of children with focal segmental glomerulosclerosis at the end of two years of the study. The therapy of IV methylprednisolone followed by oral prednisolone for one year plus 6 month pulse cyclophosphamide intravenously is beneficial for children with steroid resistant minimal change disease and diffuse mesangial proliferative glomerulonephritis. The therapy is not effective in focal segmental glomerulosclerosis.Key words: Cyclophosphamide, Methyl prednisolone, Steroid resistant nephrotic Syndrome

يبقى علاج التناذر الكلوي المقاوم للستيرويد عرضة للنقاش والجدل. العلاج الافضل لمرض التناذر الكلوي المقاوم للستيرويد غير معرف بشكل جيد. الدراسة الآنية اجريت على الاطفال الذين يراجعون مستشفى تكريت التعليمي ومستشفى بيجي العام للفترة من الاول من تموز لسنة 2004 وحتى نهاية تموز لسنة 2006. وذلك لمعرفة الفائدة من استخدام الادوية المثبطة للمناعة ( مثيل بريدنزولون الوريدي واتبعت بعلاج البريدنيزولون عن طريق الفم لمدة عام واحد، مع ست جرع متتابعة شهريا من مادة السايكلوفوسفمايد) للاطفال الذين يعانون من التناظر الكلوي المقاوم للستيرويد.وقد شملت هذه الدراسة 34 طفلا يعانون من مرض التناظر الكلوي المقاوم للستيرويد ، وقد عولجوا بالنظام المذكور اعلاه. استجابة المرض للعلاج حددت بنهاية السنة الاولى والثانية.وقد كانت الاستجابة للعلاج مع نهاية السنة الثانية من هذه الدراسة بنسبة 81.8%(9/11) من الاطفال الذين يعانون تناظر كلوي ذو التغير البسيط ، 66.7%(6/9) من الاطفال ذو التناظر الكلوي ذو الغشاء المتكاثر ، وفقد 16.7%(1/6) من الاطفال الذين يعانون من التناظر الكلوي ذو الجزء الموقعي للحبيبة المتصلة.ان علاج مثيل بريدنيزولون الوريدي والمتبوع بالبريدنيزولون الفموي لمدة سنة مع 6 جرع متتابعة شهريا من مادة السايكلوفوسفمايد الوريدي ذات فائدة للاطفال الذين يعانون من مرض التناظر الكلوي المقاوم للستيرويد ذو التغير البسيط وذو الغشاء المتكاثر . والعلاج غير فعال للجزء الموقعي للحبيبة المتصلة


Article
Clinicopathological Findings of IgA Nephropathy in Children and Adolescents; (Multicentn Study)

Author: Alaa M. Neamah*, Ammar A. Hussein** ,Hasanein H. Ghali*** , Qutaiba A. Hussein**
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 3 Pages: 338-343
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: IgA nephropathy (IgAN) is the most common lesion found to cause primary glomerulonephritis throughout most developed countries of the world. Patients may present at any age, but there is a peak incidence in the second and third decades of life. OBJECTIVE:To study the demographic, clinical and laboratory findings of IgAN patients including children and adolescents.METHODS: The medical records of 30 patients with IgAN were retrospectively reviewed and assessed. Patients enrolled in this study were between 1-18 years old diagnosed as IgAN in the period from January 2010 to the end of December 2012 being treated and followed in the main three centers of treating cases of pediatric nephrology in Baghdad (Al-karama teaching hospital, Central Child Teaching Hospital and Baghdad Medical City) that receive referral cases from all Iraqi governorates. RESULTS: The total number of cases enrolled in this study was 30 patients, with males being 19 and females being 11. The male to female ratio was 1.72:1. Family history of chronic renal disease was found in 10 patients (33%). History of pharyngitis was found in 16 patients (53.3%). Macroscopic hematuria was found in 24 patients (80%), followed by edema in 18 patients (60%), and followed by hypertension in 15 patients (50%). The most common laboratory findings among study group was microscopic hematuria (29 patients, 96.7%), followed by proteinuria in 22 patients (73.3%). Renal biopsy was done for all patients for the diagnosis of IgAN. The distribution of histopathology staging system was: Stage (1) 14 patients, Stage (2) 8 patients, Stage (3) 5 patients, Stage (4) 2 patients and Stage (5) 1 patient (46.7%, 26.7%, 16.7%, 6.7% and 3.3% respectively). The study showed that 24 patients were found to have IgA deposited solely (80%). Out of the total 12 patients presented with hematuria, nine of them (75%) showed stage 1 disease on histopathology study. Two patients were noticed to have other associated autoimmune diseases, one with hepatitis and another with ulcerative colitis. CONCLUSION: Further studies in large number of patients are needed in order to confirm the findings in this study and to establish the best therapeutic choice for IgAN. The need for immunofluorescence examination of the renal biopsies in suspected cases is recommended.


Article
Clinical and pathological characteristics of primary focal segmental glomerulosclerosis in adult
الخصائص السريرية والمرضية للتصلب الكبيبي القطاعي الأساسي في البالغين

Authors: Salam Fareed Wadee --- Safa Ezzidin Al-Mukhtar
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2017 Volume: 21 Issue: 1 Pages: 1645-1652
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Background and objective: Focal segmental glomerulosclerosis shares overlapping patterns of injury with segmental consolidation and obliteration of glomerular architecture by the accumulation of collagenous extracellular matrix or by increased cellularity or both. This study aimed to investigate the patterns of primary focal segmental glomerulosclerosis in adults in Erbil. The specific objectives of this study included determining the frequency of histological variant of Focal segmental glomerulosclerosis, defining the clinical characteristics of the primary type in general and recognizing the clinical and pathological characteristics for each variant separately.Methods: A cross-sectional, clinico-pathologic study was conducted for 50 patients attending the Nephrology Department in Erbil Teaching Hospital between March and December 2013. This study included patients of >16 years old with biopsy-proven idiopathic focal segmental glomerulosclerosis. Results: A total of 50 patients were enrolled into this study. The median age of patients was 33 years, ranged from 18 to 54, 31 (62%) males and 19 (38%) females. The frequency of histopathological variants was 80% not otherwise specific focal segmental glomerulosclerosis, 14% glomerular tip lesion, and 6% cellular type. Nephrotic syndrome and hypertension were the main presenting features (92% and 68%, respectively). The mean percentage of sclerosed glomeruli was 40% and the mean interstitial fibrosis and tubular atrophy was 24%.Conclusion: A not otherwise specific variant is a common morphological lesion in many glomerular and non-glomerular diseases, and it is just like a junk drawer of multiple glomerular alterations with this common pattern of the lesion.


Article
Assessment of mothers' practices toward children with steroid – sensitive nephrotic syndrome at pediatrics hospitals in Baghdad city

Authors: Feryal A. Zyarah --- Eqbal G. Mua’ala
Journal: nursing national Iraqi specility المجلة العراقية الوطنية للعلوم التمريضية ISSN: 18122388 Year: 2011 Volume: 24 Issue: 2 Pages: 1-25
Publisher: Baghdad University جامعة بغداد

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Objective(s): To assess mothers' practices toward children with steroid – sensitive Nephrotic Syndrome (SSNS) who are visiting nephrology consultation units, and to find out the relationships between their practices and the demographical data for mother and child. Methodology: A descriptive study was carried out at nephrology consultation units of Baghdad pediatrics hospitals (Child's Central Pediatric Teaching Hospital, Al-kadimiyia Teaching Hospital, and Welfare Teaching Hospital) started from February 18th to the end of July 2009. A purposive sample of (80) mothers who company their children were selected. The data were collected through a constructed questionnaire, with two parts; the first part is concerned with mother's and child's demographical characteristic, the second part is concerned with mothers' practices about steroid– sensitive nephrotic syndrome. An interview method was used to full questionnaire format. The validity was determined through a panel of experts. While, the reliability was determined through a pilot study. The data were analyzed by using descriptive and inferential statistical measures by using the statistical package of social science (SPSS) version (15).Results: The findings of the study showed that mothers have poor practices (61.3%). The study results revealed that there is a significant association between mothers' practices and their educational level, and duration of the child's disease. While mother's age, occupation, child's age, child's sex, child's age at onset (years), child's previous disease and heredity have no association with their practices. Recommendations: The study recommends that health education for mothers would improve their practices.

الهـدف: تهدف الدراسة إلى تقييم ممارسات الأمهات باتجاه الأطفال المصابين بمتلازمة التناذر الكلوي المتحسس للستيرويد، اللواتي يراجعن الوحدات الإستشارية لأمراض كلى الأطفال، وإيجاد العلاقة بين هذه الممارسات والصفات الديموغرافية للأم والطفل. المنهجية: دراسة وصفية أجريت في الوحدات الإستشارية لأمراض كلى الأطفال في مستشفيات الأطفال (مستشفى الطفل المركزي، مستشفى حماية الأطفال، مستشفى الكاظمية التعليمي) للمُدّة من الثامن عشر من شهر شباط ولغاية نهاية شهر مايس 2009. عيّنة غرضية من (80) أم مرافقة لطفلها. جُمعت المعلومات من خلال بناء استمارة استبيانية تكوّنت من قسمين؛ القسم الأول يخص الصفات الديموغرافية للأم والطفل، والقسم الثاني يخص ممارسات الأمهات عن متلازمة التناذر الكلوي المتحسس للستيرويد. أُستعمِلَ أسلوب المقابلة مع الأمهات لغرض ملء الاستمارة. تمّ تحديد مصداقية الاستبانة من خلال مجموعة خبراء. أمّا الثبات، فقد تمّ تحديده من خلال الدراسة الاستطلاعية وأجريَ تحليل المعلومات إحصائياً وفقاً لنظام التحليل الإحصائي الوصفي للعلوم الاجتماعية الإصدار (15) باستعمال التحليل الوصفي والاستنتاجي. النتائـج: أظهرت نتائج الدراسة أنّ ممارسات الأمهات ضعيفة بنسبة 61.3%. كشفت نتائج الدراسة وجود علاقة إحصائية بين ممارسات الأمهات والمستوى الثقافي للام، ومُدّة إصابة الطفل بالمرض. بينما عمر الأم، وظيفة الأم، عمر الطفل، عمر الأم، جنس الطفل، تاريخ ظهور المرض، الأمراض السابقة للطفل، الوراثة لم تظهر أي علاقة ذات دلالة إحصائية معنوية.التوصيـات: أوصت الدراسة بالتثقيف الصحي حول المرض للأمهات والذي قد يحسن ممارساتهن.


Article
Childhood Nephrotic Syndrome, Frequent and Infrequent Relapses and Risk Factors for Relapses

Authors: Kasim Rahi --- Adel Abdul Salam AL-Badri --- Bushra Jalil Salih --- Faleeha Obaid Hasan
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 291-295
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Most patients with steroid sensitive nephrotic syndrome (SSNS) have frequent relapses until disease resolve spontaneously toward the end of second decade of life and so the main problem in such disease is frequent relapses and their association with complications of disease or side effects of drugs used in each relapse.OBJECTIVE:In this study, we evaluate different factors which might be associating or leading to occurrence of frequent relapses.PATIENTS AND METHODS:A retrospective study was done in the Central Child Teaching Hospital from Feb. 2007 - Feb. 2008, during this period, 120 patients with nephrotic syndrome (NS) randomly selected who were diagnosed & or treated in this hospital. Out of 120 patients, 85 (70.8%) patients with steroid sensitive nephrotic syndrome (SSNS), 9 (7.5%) patients with steroid dependant nephrotic syndrome (SDNS) and 26 (21.7%) patients with steroid resistant nephrotic syndrome (SRNS). The steroid sensitive patients were divided into 24 (28.2%) patients as undetermined (UD) group, 35 (41.2%) patients with frequent relapses (FR) group and 26 (30.5%) patients with infrequent relapses (IFR) group. We compare between frequent and infrequent groups regarding to age, sex, type of presentation, biochemical finding, precipitating factors, family history of renal disease, the time needed to responsd to steroid therapy and duration of steroid therapy.RESULTS:The age ranged from 1-16 years, with peak incidence at age group from 1-5 years. There were 64 patients (53.3%) presented with this age group, most of them were steroid sensitive nephrotic syndrome 53 (82.5%) patients. There were 73 male and 47 female & M: F ratio 1.5: 1, most of them (70.8%) with steroid sensitive nephrotic syndrome & male to female ratio was 1.8: 1. The main type of presentation was preiorbital oedema; the main type of precipitating factor was respiratory tract infection. The family history of renal disease (P value = 0.0006) and the delay in response to steroid therapy, 2 weeks and more (P value = 0.0477 & 0.0486) were statistically significant correlation with frequent relapsers (FR) group in comparison to infrequent (IFR) group.There were no statistically significant differences between frequent and infrequent groups regarding other factors.CONCLUSION:There were significant correlation between family history of renal disease & delay in response to steroid therapy with occurrence of frequent relapses supporting other studies but this study fails to confirm previous studies about other factors


Article
Options of the Treatment in Steroid Resistant Nephrotic Syndrome in Children in Central Child Teaching Hospital-Baghdad

Authors: Kasim Rahi Issa --- Bushra Jalil Salih --- Taghreed F. Mohammed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 3 Pages: 316-320
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: The therapy of steroid resistant nephrotic syndrome (SRNS) is still a matter of controversy. OBJECTIVE: To assess the options of treatment in SRNS PATIENT AND METHOD: A retrospective study to 50 patients randomly selected in the Central Child Teaching Hospital during study period from Jan. 2006 to July 2008. The patients age were between 6 months.-18 years. All patients who had failed to achieve an improvement in proteinuria after minimum of 4 weeks (up to 8 weeks) of prednisolone (PDN) in a dosage 2 mg/kg/day were taken. Only the patients with idiopathic nephrotic syndrome (45 patients) were involved in the study but the patients with secondary nephrotic syndrome and congenital neprosis were excluded from the study. Each patient were individualized to the type of pathology and to the type of medication used. RESULTS: Forty five patients were included in the study, the age range between 6 months.-18 years. Twenty eight patients were male and 17 were female, M: F ratio 1.64: 1. Regarding the type of pathology, 20 patients with focal segmental glomerulosclerosis (FSGS), 11 patients with minimal change nephrotic syndrome (MCNS), 8 patients with diffuse mesangial proliferation (DMP) and 6 patients were unknown biopsy (not down biopsy). The drugs that used were methyl prednisolone (MP) in 17 patients, Every other day steroid (EODS) in 10 patients, cyclosporineA (CsA) plus EODS in 16 patients (10 patients as first option and 6 patients as second option), cyclophosphamide (CYS) used in 8 patients (6 patients as first option and 2 patients as second option) and chlorambucil were used in 2 patients only. The response was higher in patients who received EODS (50%), followed by the patients who received CsA plus EODS (25%) then the patients who received MP(23.5%) and the patients who received CYS(12.5%) and chlorambucil(zero%). The response to treatment was higher in females than males, 11 out of 28 males (39.28%) responded to treatment while 7 of 17 female (41.17%) responded to treatment. The patients with early presentation responded to treatment higher than those with late presentation, so 12 of 19 patients (63.15%) presented early while 10 of 26 patients (38.46%) presented late. According to histopathology, the patients with unknown etiology had higher rate of response, 3 out of 6 patients (50%) responded to treatment followed by 7 of 20 (35%) patients with FSGS, then 2 of 8 (25%) patients with DMP, then 2 of 11 (18.18%) patients with MCNS. CONCLUSION: The drugs used are the common drugs and EODS is preferable type of medication used in SRNS


Article
Evaluation of Serum (immunoglobulin G, M) in children with nephrotic syndrome relapse
تقيم المصل للغلوبينات المناعية G,M لدى الاطفال الذين يعانون من الانتكاس لمتلازمةالتناذر الكلوي

Author: Nariman F. A.Azat نريمان فهمي احمد عزت
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2012 Volume: 54 Issue: 1 Pages: 15-17
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Nephrotic syndrome is an immune mediated disorder of the kidney associated with T cell dysfunction and secondary disturbance of B cell with changes in levels of immunoglobulin. Objectives: The objectives of this study were to compare immunoglobulin levels in children with nephrotic syndrome in relapse and healthy children, and to assess relationship between the degree of albuminuria and the mean concentrations of immunoglobulin.Methods: We studied 60 children with nephrotic syndrome during January 2008 to January 2011 in the Pediatric Nephrology consultation clinic, Children Welfare Teaching Hospital –Baghdad Medical Complex –Iraq. Urine protein and blood samples were collected from the 60 patients, and serum levels of IgG, IgM were measured. Another 20 healthy children attending the clinic were enrolled as controls.Results: In the 60 relapse cases of steroid sensitive nephrotic syndrome, compared with healthy children, the IgG level was low, IgM level was high and a highly significant relationship was found between the degree of albuminuria and the mean concentration of immunoglobulin in sera of patients (p< 0.01)Conclusion: immunoglobulin abnormalities support growing evidence that functional glomerular changes in nephrotic syndrome may result from T-cell disturbance and B-cell involvement.Key words:

خلفية: المتلازمة الكلوية هو اضطراب المناعة بوساطة الكلى المرتبطة بخلل الخلايا(T) و اضطراب ثانوي في الخلايا (B) مع التغييرات في مستويات الغلوبولين المناعيالأهداف: أهداف هذه الدراسة هي المقارنة بين مستويات الغلوبولين المناعي في الأطفال الذين يعانون من المتلازمة الكلوية في الانتكاس والأطفال الأصحاء، وتقييم العلاقة بين درجة بيلةالبروتين وتركيزات متوسط الغلوبين المناعي. طريفة العمل: لقد درسنا 60 طفلا مع متلازمةالتناذر الكلوية خلال شهر يناير 2008 الى يناير 2011 في العيادةالاستشاريةلأمراض الكلىللاطفال في مستشفى حماية الاطفال التعليمي مجمع مدينة الطب- بغداد -العراق .لقد تم جمع بروتين البول وعينات الدم من60 من المرضى ، وتم قياس مستويات المصل للغلوبين المناعي وتم تسجيل 20 طفلا آخر صحي حضروا العيادة كمجموعة سيطرة. النتائج: كان مستوى الغلوبولين المناعيG في حالات الانتكاس للاطفال من المتلازمة الكلوية الحساسة الستيرويد منخفضا، وكان هناك ارتفاعا في مستوى الغلوبولين المناعيM وعثر على علاقة كبيرة جدا بين درجة بيلة البروتين ومتوسط تركيز الغلوبولين المناعي في أمصال المرضى.الخلاصة: المتغيرات في الغلوبينات المناعية تدعم ألادلة المتزايدة على أن التغييرات الوظيفية في الكبيبات الكلوية للمرضى في متلازمة التناذر الكلوي قد تنجم عن اضطراب في خلايا TوخلاياB.

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