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.

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Page 1: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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.

Page 2: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

Introduction

Page 3: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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.

Page 4: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

95% cases of nephrotic syndrome are idiopathic with 80% cases having minimal change histology synonymous with steroid responsive nephrotic syndrome.

Page 5: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha
Page 6: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

Aim

Study of relationship between Nephrotic syndrome especially steroid responsive type and clinical allergies in children.

Page 7: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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.

Page 8: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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.

Page 9: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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)

Page 10: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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.

Page 11: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

Observations

Page 12: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

Sex Distribution among study groups.

Group A Group B Group C0

102030405060708090

5340

20

27

30

20

FemaleMale

Page 13: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

Incidence of allergy in Nephrotic syndrome.

5164%

2936%

Cases of Nephrotic Syndrome (n=80)

With AllergyWithout Allergy

Page 14: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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)

Page 15: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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

Page 16: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

Incidence of various allergies in nephrotic syndrome.

05

101520253035404550 46

9 72

Number of Nephrotic Syndrome cases.

Number of Nephrotic Syndrome cases.

Page 17: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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)

Page 18: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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

Page 19: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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

Page 20: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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.

Page 21: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

Conclusion

Page 22: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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.

Page 23: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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.

Page 24: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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.

Page 25: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

Finally, there was a significant familial history of allergy in cases of nephrotic syndrome.

Page 26: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

Thank You!!

Page 27: Correlation study between steroid responsive nephrotic syndrome with clinical allergies in children at tertiary care centre in Odisha

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.