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Related Experiment Videos

Is there really an increase in non-minimal change nephrotic syndrome in children?

Guido Filler1, Elizabeth Young, Pavel Geier

  • 1Division of Pediatric Nephrology, Department of Pediatrics and Laboratory Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada. filler@cheo.on.ca

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|December 5, 2003
PubMed
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The incidence of childhood focal segmental glomerulosclerosis (FSGS) is increasing, but current treatment guidelines for nephrotic syndrome (NS) remain appropriate. Renal biopsy is not recommended unless initial corticosteroid therapy fails.

Area of Science:

  • Pediatric Nephrology
  • Glomerular Diseases
  • Epidemiology

Background:

  • Reports of rising focal segmental glomerulosclerosis (FSGS) in children may be influenced by referral bias.
  • A potential true increase in FSGS incidence could impact current practices for childhood nephrotic syndrome (NS) management.

Purpose of the Study:

  • To determine the actual incidence of FSGS in a pediatric population.
  • To evaluate the diagnostic performance of remission time for predicting NS outcomes.
  • To assess if current indications for renal biopsy in childhood NS require revision.

Main Methods:

  • Analysis of a 17-year mandatory referral database (275,000 children).
  • Calculation of NS incidence rates and review of 159 NS patient charts (1985-2002).

Related Experiment Videos

  • Receiver operating characteristic (ROC) plot analysis of remission time for diagnostic accuracy.

    • Main Results:

    • FSGS incidence significantly increased from 0.37 to 0.94 per 100,000 children/year (P=0.0253).
    • Minimal change NS was diagnosed in 115/159 patients; 29/159 had FSGS on biopsy.
    • ROC analysis showed >80% sensitivity/specificity for remission times between 21-28 days.

    Conclusions:

    • Confirmed increasing incidence of FSGS in children with idiopathic NS within a defined area.
    • No change in initial therapy or current indications for renal biopsy in childhood NS is warranted.