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Ital J Pediatr. 2015 Mar 21;41:19. doi: 10.1186/s13052-015-0123-9.

Steroid-sensitive nephrotic syndrome in children: triggers of relapse and evolving hypotheses on pathogenesis.

Author information

1
Department of Paediatric Nephrology Unit, University of Nigeria Teaching Hospital, Postal code- 400001, Ituku-Ozalla, Enugu, Enugu State, Nigeria. snuwaezuoke@yahoo.com.

Abstract

Nephrotic syndrome remains the most common manifestation of glomerular disease in childhood. Minimal change nephropathy is the most common cause of the syndrome in children. Despite its initial high response rate to corticosteroids and its favorable prognosis, relapses are common leading to increased morbidity and cost of treatment.This review seeks to appraise the common triggers of relapse and to highlight the evolving hypotheses about the pathogenesis of the syndrome. Literature search was conducted through PubMed, Google web search and Cochrane Database of Systematic reviews using relevant search terms.Acute respiratory infections and urinary tract infections are the most frequent infectious triggers of relapse. Targeted interventions like initiating corticosteroid or its dose-adjustment during episodes of acute respiratory infection and zinc supplementation are reportedly effective in reducing relapse rates. Hypotheses on pathogenesis of the syndrome have evolved from the concepts of 'immune dysregulation', 'increased glomerular permeability' to 'podocytopathy'.Although development of drugs which can regulate the pathways for podocyte injury offers future hope for effective and targeted treatment, the relapse-specific interventions currently contribute to significant reduction in disease morbidity.

PMID:
25888239
PMCID:
PMC4379699
DOI:
10.1186/s13052-015-0123-9
[Indexed for MEDLINE]
Free PMC Article

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