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!!

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