Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background: Steroid-resistant nephrotic syndrome (SRNS) patients are candidates for other alternative drug regimes, and the non-responsiveness to steroid is more common among glomerulonephritides other than minimal change disease. Without performing biopsy and proper renal histology, progression of the disease cannot be assessed. Fractional excretion of magnesium (FE Mg) has been found to correlate directly with various renal histologies. Objective: To evaluate the relationship of FE Mg in children with the histological pattern in SRNS. Methods: 60 children of nephrotic syndrome, both with the first episode as well as relapse, aged 1{u2013}12 years were included in this study. Of them, 30 were steroid-responsive cases and 30 were steroid-resistant cases. FE Mg was determined in all the patients and renal histology was performed in the steroid-resistant cases. Results: A correlation was found between FE Mg and renal histology. The results of histopathology showed that the mean difference in FE Mg was significant (P <0.001), as FE Mg was 7.88 ± 1.20 in membranoproliferative glomerulonephritis (MPGN), 6.61 ± 0.94 in focal segmental glomerulosclerosis (FSGS), 4.87 ± 0.64 in immunoglobulin M nephropathy, 4.78 ± 0.32 in diffuse mesangial proliferative glomerulonephritis, 4.66 ± 0.70 in minimal change nephrotic syndrome (MCNS) and 3.25 ± 0.29 in mild mesangial proliferative glomerulonephritis. There was a statistically significant difference between FE Mg in steroid-resistant nephrotic syndrome (5.35 ± 1.55) and steroid responsive syndrome (1.04 ± 0.44). Conclusion: FE Mg is a simple, minimally invasive screening marker for SRNS, and is an early predictor of clinical outcome. It can be considered as an initial investigation where biopsy cannot be performed or indications are not clear

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