Proteinuria selectivity and prednisone response in children with nephrotic syndrome
Gustavo Pérez-Cortés1, J Jesús Pérez-Molina2, Cristina Ochoa-Ponce1
1Nuevo Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", División de Pediatría, Servicio de Nefrología Pediátrica.
Insights
The proteinuria selectivity index (PSI) predicts prednisone response in primary nephrotic syndrome (PNS). A PSI ≥ 0.20 indicates poor response, while PSI ≤ 0.10 suggests satisfactory outcomes in pediatric patients.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Clinical Medicine
Background:
- Primary nephrotic syndrome (PNS) is a common kidney disorder in children.
- Predicting treatment response is crucial for managing PNS.
- The proteinuria selectivity index (PSI) has shown potential in predicting prednisone responsiveness.
Purpose of the Study:
- To investigate the association between the proteinuria selectivity index (PSI) and prednisone response in pediatric patients with PNS.
- To determine if PSI can serve as a reliable biomarker for predicting treatment outcomes in PNS.
Main Methods:
- An analytical cross-sectional study was conducted with pediatric patients diagnosed with PNS.
- Patients were categorized into groups with good or poor response to prednisone based on relapse frequency.
- PSI was calculated using serum and urinary measurements of IgG and transferrin, with statistical analysis including Chi square and Odds Ratio (OR).
Main Results:
- Out of 67 patients, 49.3% showed a good response and 50.7% a poor response to prednisone.
- A PSI ≥ 0.20 mg/mg was significantly associated with a poor response to prednisone (67.6% of poor responders vs. 18.2% of good responders, p < 0.001).
- A PSI ≤ 0.10 mg/mg was more common in patients with a good response to prednisone (60.6% vs. 8.8%, p < 0.001).
Conclusions:
- In pediatric patients with PNS, a high PSI (≥ 0.20 mg/mg) is indicative of a poor response to prednisone.
- Conversely, a low PSI (≤ 0.10 mg/mg) is associated with a satisfactory response to prednisone treatment.
- PSI is a valuable tool for predicting prednisone treatment outcomes in children with primary nephrotic syndrome.
Background:
The proteinuria selectivity index (PSI) can predict the response to prednisone in the primary nephrotic syndrome (PNS).
Objective:
To determine the association of prednisone response with the PSI in patients with PNS.
Material And Methods:
With analytical cross-sectional design, pediatric patients with PNS were studied with at least six months of prior follow-up, at the Nuevo Hospital Civil de Guadalajara from 2014 to 2015. They were divided into poor response to prednisone (frequent relapses or resistance) and good response (habitual relapses). PSI was calculated with serum and urinary measurement of IgG and transferrin. Chi square and OR were used, with 95% CI.
Results:
67 patients with relapsing PNS were studied. The response to prednisone had been good in 33 (49.3%) and poor in 34 (50.7%). The PSI was ≤ 0.10 mg/mg in 23/67 (34.3%); 0.11-0.19 mg/mg in 15/67 (22.4%); and ≥ 0.20 mg/mg 29/67 (43.3%). 3/34 patients (8.8%) presented ≤ 0.1 mg/mg with poor response to prednisone and 20/33 presented good response (60.6%) (p < 0.001; OR: 0.6; 95% CI, 0.010-20). PSI between 0.11-0-19 mg/mg occurred in 8/34 patients (23%) with poor response to prednisone and in 7/33 with good response (21%). PSI ≥ 0.20 mg/mg resulted in 23/34 patients (67.6%) with poor response to the steroid and in 6/33 with good response (18.2%) (p < 0.001; OR: 9.4; 95% CI, 3.01-29.42).
Conclusions:
In children with PNS, a PSI ≥ 0.20 mg/mg was associated with a poor response to prednisone treatment and a PSI ≤ 0.10 mg/mg with a satisfactory response.
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