Abstract
THE RESPONSE TO THE IMMUNOSUPPRESSIVE DRUGS IN CHILDHOOD NEPHROTIC SYNDROME IN AL KARAMA TEACHING HOSPITAL: RETROSPECTIVE COHORT STUDY

Israa A. Hammoodi* and Ammar A. Hussein

ABSTRACT

Nephrotic syndrome is a common renal disease in children sometimes need treatment with immunosuppressive drugs apart from steroid. Aim: to evaluate the response to immunosuppressive drugs in childhood nephrotic syndrome, the rate of sustained remission and the adverse effect of these drugs. Methods: retrospective study of 120 recorded files from them 68 patients with steroid sensitive nephrotic syndrome SSNS and steroid resistance SRNS, aged 1-19 years old, these children were treated and followed in Alkarama teaching hospital for 4years, the study started in the first of of April to the end of November 2015, the information data recorded were age, gender, body mass index BMI, Blood pressure, hematuria, s. cholesterol, s. albumin, urine protein: creatinine ratio, s. creatinine at presentation. The number of patient use the immunosuppressive drug, dose, duration, response, and adverse effect of each drug. Results: Sixty eight patients file records were evaluated 40 patients were SSNS and 28 patients were SRNS, male: female ratio were 2.3:1 and 1.5:1 for SSNS and SRNS respectively, clinical and laboratory data at presentation were not statistically significant except for hypertension which is statistically significant among SRNS and urine protein: creatinine ratio among SSNS. The remission rate among patient used cyclosporine were 50%(20/40) for SSNS, and for SRNS 39%(11/28), Tacrolimus were 25%(10/40) for SSNS and 10.7%(3/28) for SRNS, mycophenolate mofetil MMF 12.5%(5/40) for SSNS and 10.7%(3/28) for SRNS, Cyclophosphamide CYP 10%(4/40) for SSNS and 3.57%(1/28) for SRNS, Rituximab 2.5%(1/40) for SSNS and 7.14%(2/28) for SRNS. The most reported adverse effects were observed with cyclosporine which are gum hypertrophy 23%, hypertension 23%, hirsutism 19.23% and hyperkalemia 15.3% were most reported, with Tacrolimus the patients developed hypertension 11% and hyperglycemia 11%, with MMF gastrointestinal problem 12.5%, with CYP infection 9% and leukopenia 9% and with rituximab leukopenia 20% and thrombocytopenia 20% of cases. Conclusion: the responder to steroid and infrequent relapsers are more frequent than frequent relapsers FRNS and the later more frequent than SRNS. Hypertension are more statistically significant among SRNS and urine protein to creatinine ratio among SSNS. The best IS drug among SSNS and SRNS was cyclosporine and the most reported adverse effect were gum hypertrophy, hypertension and hirsutism.

Keywords: Urolithiasis, Biochemical analysis, Prevention, Recurrence.


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