| Complete remission of nephrotic syndrome in an infant with focal segmental glomerulosclerosis: is it renin-angiotensin blockade? | |
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MedLine Citation:
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PMID: 18853198 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Nephrotic syndrome presenting in the first year of life is often challenging, with substantial risk of progression to end-stage renal disease (ESRD). Focal segmental glomerulosclerosis (FSGS) comprises up to 20% of biopsy-proven glomerular disease in children and adults. We report on a 9-month-old infant who presented with nephrotic syndrome, hypertension and progressive deterioration of renal function due to FSGS. As immunosuppressive agents are often unsuccessful in treating this condition, we adopted renoprotection as the mainstay treatment for this patient, through rigorous control of blood pressure and proteinuria with a multi-drug regimen including renin-angiotensin axis blockade. Initially, there was partial improvement, with a gradual decline in proteinuria and a concomitant rise in the glomerular filtration rate, before the disease eventually passed into complete clinical and laboratory remission. We speculate that infants with steroid-resistant nephrotic syndrome due to FSGS may benefit from tight control of hypertension, mainly though early blockade of the renin-angiotensin axis. We believe that its renoprotecive mechanism counteracts the deleterious effects of both hypertension and proteinuria, thereby not only preventing progressive renal disease, but even paving the way for a remission, as in our patient. To the best of our knowledge, this is the first report of an infant with nephrotic syndrome (NS) due to FSGS that passed into complete remission while the patient was on renoprotective measures including the use of angiotensin-converting enzyme inhibitors (ACEis). |
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Authors:
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Neveen A Soliman; Magdi Francis; Saskia F Heeringa; Gil Chernin |
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Publication Detail:
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Type: Case Reports; Journal Article Date: 2008-10-14 |
Journal Detail:
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Title: Pediatric nephrology (Berlin, Germany) Volume: 24 ISSN: 1432-198X ISO Abbreviation: Pediatr. Nephrol. Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-03-24 Completed Date: 2009-07-16 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8708728 Medline TA: Pediatr Nephrol Country: Germany |
Other Details:
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Languages: eng Pagination: 1065-70 Citation Subset: IM |
Affiliation:
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Department of Pediatrics, Cairo University, Center of Pediatric Nephrology & Transplantation, Cairo, Egypt. neveenase@yahoo.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Albumins
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therapeutic use Amlodipine / therapeutic use Angiotensins / antagonists & inhibitors* Antihypertensive Agents / therapeutic use* Captopril / therapeutic use* Drug Resistance / drug effects Drug Therapy, Combination Furosemide / therapeutic use Glomerulosclerosis, Focal Segmental / complications, drug therapy*, pathology Humans Infant Labetalol / therapeutic use Male Nephrotic Syndrome / drug therapy*, etiology, pathology Prednisolone / pharmacology Remission Induction Renin-Angiotensin System / drug effects*, physiology |
| Chemical | |
Reg. No./Substance:
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0/Albumins; 0/Angiotensins; 0/Antihypertensive Agents; 36894-69-6/Labetalol; 50-24-8/Prednisolone; 54-31-9/Furosemide; 62571-86-2/Captopril; 88150-42-9/Amlodipine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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