Patients with Idiopathic Nephrotic Syndrome Essay -- Health, Treatment

Introduction It is known that glucocorticoids (GCs) therapy is the treatment of choice for patients with idiopathic nephrotic syndrome (INS); however some patients fail to respond to the treatment even when given high-dose GCs. For those patients, the treatment should be bolstered by synergising GCs with other immunosuppressant [1]. Although biochemical alterations and clinical manifestations in most nephrotic patients seem to be quite similar, substantial differences are encountered regarding the course of disease. Relapses of proteinuria are experienced in approximately 60% to 80% of steroid-sensitive nephrotic syndrome patients and despite initial complete remission some remain steroid dependent or become steroid-resistant [2]. The lack of response to corticosteroids has been explained by several mechanisms. This may be ascribed to overwhelming disease severity, poor compliance, abnormalities in glucocorticoid metabolism or poor absorption, especially in patients with NS, who often develop heavy proteinuria and Hypoalbuminaemia, and, finally, by GCs resistance due to a GCR or postreceptor abnormality. GCR was incriminated in worsening the response to steroids earlier [3,4], but inadequate response to these agents, either due to inherited target tissue defective response or acquired impaired responsiveness is often reported by the clinicians in a number of patients [5]. If clinical response was predicted before therapy, synergised treatment might be performed at the beginning of the treatment to avoid side effects of chronic high-dose hormone therapy, which could improve the individual response to GC therapy and benefit more patients. Glucocorticoid receptor (GCR) seems to be related to the pathogenesis of steroid... ...ic indicator for patients with idiopathic nephrotic syndrome. During follow-up patients with non-relapsing and infrequent relapsing nephrotic syndrome had a median time to achieve remission 7 days [5]. Thus taken together all those data we can speculate that evaluation of the expression of intracellular glucocorticoid receptors shown as the percentage of lymphocytes (CD3/GCR) can directly predict early and late responders to steroid therapy, and as a result the outcome of nephrotic syndrome patients regarding future relapses if any. However, there has been no study on the relationship between the expression of lymphocytes GCR and the time to achieve complete remission in pediatric age group patients with steroid sensitive nephrotic syndrome so far.