Prognostic factors in children with membranoproliferative glomerulonephritis type I.

The clinical outcome of patients with membranoproliferative glomerulonephritis (MPGN) varies, with some patients progressing to end-stage renal disease. The aim of this retrospective study was to analyze the initial clinical signs and laboratory test results associated with an MPGN prognosis. The study cohort consisted of 47 patients with idiopathic MPGN Type I treated at the National Institute of Pediatrics, Mexico City, between 1971 and 2001. The median follow-up was 3 years. The three different outcomes of interest were death, renal failure, and nephrotic syndrome. The patients' ages ranged between 4 and 16 years. All patients had different degrees of proteinuria, hyperlipidemia, and microscopic/macroscopic hematuria, and 85.1% of them showed hypocomplementemia. Clinical outcomes varied, however, the most common was nephrotic syndrome, either alone or combined with other syndromes, which accounted for 74.5% of all cases. Fifteen patients died. Treatment with methylprednisolone improved the patient's condition, while the use of chloroquine or cyclophosphamide worsened it. Twenty-two patients had some degree of renal failure; glomerular filtration rate (GFR) levels and albumin values were negatively associated to renal failure, while treatment with methylprednisolone decreased the probability of renal failure. Nephrotic syndrome persisted in 18 patients; hemolytic complement and hemoglobin values were negatively associated with nephrotic syndrome, while macroscopic hematuria was positively associated with it. Signs that suggested a poor prognosis during diagnosis were low GFR, low albumin, low hemolytic complement, and macroscopic hematuria. Treatment with methylprednisolone seemed to improve prognosis, however, this needs to be confirmed with randomized studies.

Clinico-pathological study on the nephrotic syndrome in Jamaican children

A review of eleven years of hospital admission for childhood nephrotic syndrome is presented. Forty-two children were studied between January 1971 and December 1981. There were no significant sex differences, but 28 of the 42 children (67 percent) were 6 years of age or less, with a peak age incidence in the 2-3 years group. Children aged 6 years or under were significantly associated with responsiveness to corticosteroids, while more none-responders were over 6 years of age (P<0.0001). Seventy-five per cent of those treated with a 2-month course of corticosteroids responded within one month of treatment. Five children had a spontaneous remission of symptoms, at least 3 of whom may have had a resolving post-streptococcal glomerulonephritis (PSGN). Selective renal biopsies were performed in 24/42 (57 percent). Of these 24, minimal change disease (MCD) was present in 6, mesangial proliferative glomerulonephritis (MPGN) in 6, focal glomerulosclerosis (FGS) in 4, diffuse proliferative glomerulonephritis (DPGN) in 3 and one each of focal proliferation, membranous glomerulopathy and mesangio-capillary glomerulonephritis MCGN). As expected, biopsied children had more relapses and were more often treated with cytotoxic drugs (AU)

Causas de muerte en el niño con síndrome nefrótico / Causes of death in the child with nephrotic syndrome

Se revisan 10 casos de fallecidos con síndrome nefrótico, y se encuentra que el 50 por ciento de los mismos fallece por causas infecciosas: el 40 por ciento bacterianas, y el 10 por ciento virales, el 30 por ciento muere por insuficiencia renal crónica, concomitante, en la mayoría de ellos, con causas infecciosas; y el 20 por ciento fallece en cuadros tromboembólicos. En un mismo paciente puede asociarse más de una de estas causas para llevarlo a un desenlace funesto. Y las infecciones más frecuentes son las bacterianas, pero las virales y micóticas pueden influir notablemente en el cuadro final de estos pacientes(AU)