A REVIEW ON MANAGEMENT OF STEROID DEPENDENT AND STEROID RESISTANT NEPHROTIC SYNDROME IN CHILDREN

SK. Tanisha Bibi, B.Harsshene, Pavan Kumar Perugu, Tabitha Sharon, Padmalatha Kantamaneni

Nephrotic syndrome is a common pediatric kidney disease which is characterized by the leakage of the protein from the blood into urine through the damaged glomeruli. Nephrotic syndrome is characterized by heavy proteinuria, hypoalbunemia (serum albumin <2.5g/dl), hyperlipidemia (serum cholesterol >200mg/dl) and edema. Nephrotic range proteinuria is present if early morning urine protein is 3+/4+ (on dipstick test), spot protein/creatinine ratio >2mg/mg or >200mg/mmol urine albumin excretion >40 mg/m2 per hour. Precise quantitative measurement is necessary by 24 hour urine protein measurement Occurs at all age groups but most common in children of one year five months to six years Boys>Girls, 2:1 ratio Higher in underdeveloped countries Incidence worldwide, 2-7 cases per 100,000 children /year Nephrotic syndrome happens when tiny structures in the kidneys called glomeruli stop working properly and let too much protein enter the kidneys. Signs of nephrotic syndrome may vary significantly from child to child, but you or your child may notice: fatigue, malaise, decreased appetite, weight gain and facial swelling. A number of conditions can damage the glomeruli and cause nephrotic syndrome.[1] In children, the most common cause is due to minimal change disease. The treatment's goal is to stop the loss of protein in the urine and increase the amount of urine passed from the body. Prednisolone is the first choice of drug given followed by immunomodulators; additional drugs like ACE inhibitors, diuretics, HMG COA inhibitors are also prescribed.