correlation study between steroid responsive nephrotic syndrome with clinical allergies in children...
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Correlation study between steroid responsive nephrotic
syndrome with clinical allergies in children at tertiary care
centre in Odisha.Authors- Dr. Shreesh Bhat, Dr. Ashish
Agrawal,Dr. Narayan Prasad Modi, Dr. Saroj Kumar
Satpathy.
Introduction
Nephrotic syndrome is a common renal pediatric disorder reported in 20 – 40 million population worldwide, with incidence in Indian subcontinent being 90-100 per million.
It is characterized by generalized edema, heavy proteinuria, hypo-albuminemia, and hyperlipidemia.
95% cases of nephrotic syndrome are idiopathic with 80% cases having minimal change histology synonymous with steroid responsive nephrotic syndrome.
Aim
Study of relationship between Nephrotic syndrome especially steroid responsive type and clinical allergies in children.
Objectives1. Relate concurrence of steroid responsive
nephrotic syndrome and clinical allergies.
2. Relate Serum IgE levels in steroid responsive nephrotic syndrome and clinical allergies.
3. Relate familial occurrence of allergy in cases of nephrotic syndrome.
Materials and Methods.
Type of Study:- Cross-sectional study
Place of study :- Dept. of Pediatrics, SCB Medical college and SVPPGIP, Cuttack, Odisha.
Duration of Study:- 2 years.
(Sept. 2013 to Aug. 2015 )
Appropriate consent from all participants and Ethics committee approval taken before starting study.
Three groups were studied with sample size and description as follows.
Group A- Cases (Nephrotic Syndrome).(n=80)
Group B (Control) - Children primarily presenting for non atopic conditions but who may be having history of or existing clinical allergy.(n=70)
Group C (Control) - Healthy Children. (n=40)
INCLUSION CRITERIA:Children 2-10 years of age.Children having clinical and biochemical
evidence of Nephrotic syndrome.
EXCLUSION CRITERIA:Children < 1year.Children with nephrotic syndrome with
associated features of azotemia, hematuria, hypertension.
Children with immunodeficiency disorders.Children with edema due chronic liver disease,
CCF, severe malnutrition etc.
Observations
Sex Distribution among study groups.
Group A Group B Group C0
102030405060708090
5340
20
27
30
20
FemaleMale
Incidence of allergy in Nephrotic syndrome.
5164%
2936%
Cases of Nephrotic Syndrome (n=80)
With AllergyWithout Allergy
INCIDENCES OF ALLERGIC DISORDER AMONG STUDY GROUPS.
Group A Group B Group C0
10
20
30
40
50
6051
13
5
29
57
35
With AllergyWithout Allergy
(p<0.05)
Incidence of clinical allergies in First attack and relapsing nephrotic syndrome.
First Attack Relapsing0%
10%20%30%40%50%60%70%80%90%
100%
7 44
3 26
Without AllergyWith Allergy
Incidence of various allergies in nephrotic syndrome.
05
101520253035404550 46
9 72
Number of Nephrotic Syndrome cases.
Number of Nephrotic Syndrome cases.
INCIDENCE OF RAISED IG-E LEVEL AMONG STUDY GROUPS.
Group A Group B Group C0%
10%20%30%40%50%60%70%80%90%
100%
76
100
4
6040 Normal IgE
IgE Raised (>300IU)
Incidence of allergy among first order relatives.
Group A Group B Group C0%
10%20%30%40%50%60%70%80%90%
100%
4026 13
4044 27
No Atopy HistoryWith Atopy history in First relative
p<0.05
Incidence of eosinophilia among study groups.
Group A Group B Group C0%
10%20%30%40%50%60%70%80%90%
100%
47
5 0
33
65 40 No EosinophiliaEosinophilia
RecommendationsIn spite of best efforts taken for the study, the following improvements are suggested during further research.
Study should be conducted at a grass root level.
Larger studies could further validate results.
Appropriate follow-up done.
Relation to steroid intake studied.
Conclusion
In the present study of the 80 cases presenting with nephrotic syndrome, the incidence of four main allergies in control groups B and C (19%, 13%) were significantly lower.
64% cases (p<0.05; Significant) of nephrotic syndrome presented with clinical allergies.
Here, nephrotic syndrome was found to have a greater incidence of association with these allergies:-
Allergic rhinitis (58%), Allergic dermatitis (12%),
Asthma (9%) and food allergy (2%).
Allergic manifestation, related to relapse in none it was a consistent or concurrent happening.
In this study we found a strong significant association between Nephrotic syndrome and clinical allergies.
It was further supported by elevated levels of Serum IgE in our cases of Nephrotic syndrome.
95% cases had serum IgE >300IU/ ml.
64% cases had a mean level of >1550 IU/ml. These were the cases presenting with clinical allergies.
Finally, there was a significant familial history of allergy in cases of nephrotic syndrome.
Thank You!!
Bibliography1. Schachter AD. The Pediatric Nephrotic Syndrome Spectrum: Clinical Homogeneity And Molecular Heterogeneity. Pediatr Transplant. 2004;8:344–348.2. The Primary Nephrotic Syndrome In Children. Identification Of Patients With Minimal Change Nephrotic Syndrome From Initial Response To Prednisone. A Report Of The International Study Of Kidney Disease In Children. J Pediatr. 1981;98:561–564.3. Hardwicke J, Soothill JF, Squire JR, Holti G. Nephrotic Syndrome With Pollen Hypersensitivity. Lancet. 1959;1:500–502.4. Abdel-Hafez M, Shimada M, Lee PY, Johnson RJ, Garin EH. Idiopathic Nephrotic Syndrome And Atopy: Is There A Common Link? Am J Kidney Dis. 2009;54:945–955. Salsano ME, Graziano L, Luongo I, Pilla P, Giordano M, Lama G. Atopy In Childhood Idiopathic Nephrotic Syndrome. Acta Paediatr. 2007;96:561–566.6. Van Den Berg JG, Weening JJ. Role Of The Immune System In The Pathogenesis Of Idiopathic Nephrotic Syndrome. Clin Sci (Lond) 2004;107:125–136.7. Cheung W, Wei CL, Seah CC, Jordan SC, Yap HK. Atopy, Serum IgE, And Interleukin-13 In Steroid-Responsive Nephrotic Syndrome. Pediatric Nephrol. 2004;19:627–632.8. Grimbert P, Audard V, Remy P, Lang P, Sahali D. Recent Approaches To The Pathogenesis Of Minimal-Change Nephrotic Syndrome. Nephrol Dial Transplant. 2003;18:245–248.
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