A Comparative Study of Steroid and Steroid plus other Drugs in Relation to Growth and Renal Histopathology among Frequently Relapsing Nephrotic Syndrome Patients
Author(s): Ravi Modi, Omprakash Shukla
Background: Corticosteroid is mainstay in the management of Nephrotic syndrome, but it has potential to impair linear growth and the repeated treatment regimens expose such children to the high risk of toxicity. Renal histopathology of FRNS patients is an important guide for management.
Aim: To study the linear growth, renal histopathology, spectrum of infections and complications of steroid therapy in FRNS patients.
Material and Methods: Combined retrospective and prospective study of 44 FRNS(Frequent Relapsing Nephrotic Syndrome) patients. Data were obtained from disease onset until follow-up of at least 3 years. Group I received steroid only and group II received Cyclophosphamide, Cyclosporine, Levamisole along with Steroids.
Result: The range for age of onset of 1st attack was1-11 years with median of 5.5 years. Age distribution was 73% amongst 2-6 years and 20% in >6 years. Mean increase in height in group I was 4.89 cm/ year while in group II it was 6.43. After 3 years of treatment patients in group II had significantly higher improvement in linear growth as compared to those in group I (p<0.01). Out of 17 biopsied patients, MCNS (Minimal Change Nephrotic Syndrome)was the commonest and seen in 88%, FSGS (Focal Segmental Glomerulo Sclerosis) in 6% and MPGN (Membrano Proliferative Glomerulo Nephritis) in 6%.
Conclusion: The addition of an immunosuppressive agent to steroid therapy decreases the risk of growth retardation.Renal biopsy is a safe and effective tool, which helps in further management and predicting prognosis.