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

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Term Occurence Count Dictionary
tacrolimus 2 nephrologydiseasesdrugs
cyclophosphamide 1 nephrologydiseasesdrugs
cyclosporine 2 nephrologydiseasesdrugs
focal segmental glomerulosclerosis 2 nephrologydiseases
mycophenolate mofetil 1 nephrologydiseasesdrugs
nephrotic syndrome 21 nephrologydiseases
prednisolone 22 nephrologydiseasesdrugs
rituximab 3 nephrologydiseasesdrugs

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Select Drug Character Offset Drug Term Instance
cyclophosphamide 4076 strategies to reduce the frequency of relapses which include long-term, low-dose alternate day prednisolone, cyclophosphamide , levamisole, calcineurin inhibitors such as cyclosporine A (CsA) or tacrolimus, mycophenolate mofetil
cyclosporine 4137 long-term, low-dose alternate day prednisolone, cyclophosphamide, levamisole, calcineurin inhibitors such as cyclosporine A (CsA) or tacrolimus, mycophenolate mofetil (MMF) and rituximab.It is currently recognized that at
cyclosporine 6615 association with HLA antigens and Hodgkin’s lymphoma, and the therapeutic response to steroids and cyclosporine support the ‘immune dysregulation’ hypothesis [[21]]. In fact, abnormalities of T cell subsets and/or
mycophenolate mofetil 4173 prednisolone, cyclophosphamide, levamisole, calcineurin inhibitors such as cyclosporine A (CsA) or tacrolimus, mycophenolate mofetil (MMF) and rituximab.It is currently recognized that at least 50% of relapses are triggered by a viral
prednisolone 3712 complications such as sepsis, thrombosis, dyslipidemia and malnutrition [[12]], while treatment with high-dose prednisolone is associated with significant adverse effects like hip avascular necrosis, hypertension, diabetes and
prednisolone 4062 steroid-sparing strategies to reduce the frequency of relapses which include long-term, low-dose alternate day prednisolone , cyclophosphamide, levamisole, calcineurin inhibitors such as cyclosporine A (CsA) or tacrolimus, mycophenolate
prednisolone 5057 Recommendation statements in the clinical practice Guideline for Glomerulonephritis advises “that daily prednisolone be given during episodes of upper respiratory tract and other infections to reduce the risk for relapse
prednisolone 5264 for relapse in children with frequently relapsing and steroid dependent SSNS already on alternate day prednisolone ” [[20]].This review seeks to appraise the triggers of relapse, as well as to highlight the evolving
prednisolone 13571 obvious limitations. It is therefore not surprising that the KDIGO recommendation of initiating daily prednisolone during episodes of upper respiratory infections is tagged with a low quality of evidence (grade C) [[20]].Nevertheless,
prednisolone 14578 relapsing nephrotic syndrome were studied and were eligible for therapy with long-term, alternate-day prednisolone (0.5 mg-0.75 mg/kg) with or without levamisole (2 mg/kg). They were randomized to either receive
prednisolone 14717 or without levamisole (2 mg/kg). They were randomized to either receive their usual alternate-day prednisolone daily for 7 days during intercurrent infections (intervention group) or continue alternate-day prednisolone
prednisolone 14826 prednisolone daily for 7 days during intercurrent infections (intervention group) or continue alternate-day prednisolone (control group). Sixty eight patients were treated with alternate-day prednisolone alone while 32 patients
prednisolone 14909 continue alternate-day prednisolone (control group). Sixty eight patients were treated with alternate-day prednisolone alone while 32 patients received alternate-day prednisolone and levamisole. At the 12-month follow-up,
prednisolone 14969 patients were treated with alternate-day prednisolone alone while 32 patients received alternate-day prednisolone and levamisole. At the 12-month follow-up, there were 44 relapses (31 infection-associated) in the intervention
prednisolone 15527 5 patients (control group) while 2 patients developed cataract.Table 2Relapse rates and cumulative prednisolone dosage at 12-month follow-upIntervention groupControl groupRatepn = 49n = 46DifferenceInfection-associated0.7
prednisolone 15880 (episodes/patient per year)a0.9 ± 0.4 (0.7, 1.2)1.8 ± 0.5 (1.4, 2.2)0.9 (0.4, 1.4)<0.0001MeanDifferenceCumulative prednisolone (mg/kg per year)b120 ± 32 (105,131)138 ± 22 (112,144)16 (−26, 38)0.3aRelapse rates are the mean
prednisolone 16393 children with steroid-dependent, relapsing nephrotic syndrome were placed on a maintenance alternate-day prednisolone therapy of 0.5 mg/kg. The patients were prospectively divided into two groups with comparable age and
prednisolone 16571 into two groups with comparable age and sex distribution. Group 1 patients were advised to take daily prednisolone for 5 days starting at the time of the onset of an upper respiratory infection. Those in group 2 remained
prednisolone 16708 the time of the onset of an upper respiratory infection. Those in group 2 remained on alternate-day prednisolone during episodes of upper respiratory infection. At the end of the 2 year follow-up period, the total
prednisolone 17147 randomized, double-blind, placebo-controlled crossover trial of 40 sequential patients receiving low-dose prednisolone (<0.6 mg/kg) on alternate days as maintenance therapy. At the first sign of a presumed viral upper
prednisolone 17381 infection, the children were examined and randomly allocated to take medicine A or B containing either prednisolone or placebo in the first viral upper respiratory tract infection and vice versa in the second episode
prednisolone 17679 infection were met, the new drug was prescribed on daily basis for 1 week at the same dose as that of the prednisolone being taken by the patient on alternate-day basis. The relapse rate after viral upper respiratory infection
prednisolone 17844 The relapse rate after viral upper respiratory infection was 48% in the placebo group and 18% in the prednisolone group. Although all the three studies had some methodological flaws, they were all randomized controlled
prednisolone 18080 adequate baseline similarities between groups, and they all demonstrated that a 5 to7-day course of daily prednisolone as the intervention during infectious triggers of relapse significantly reduced the risk of relapse;
prednisolone 18856 (n = 40) or placebo (n = 41). Patients with frequent relapses also received long-term, alternate-day prednisolone . Subjects receiving zinc showed a 20% lower frequency of relapses with 44.7% of the patients having
prednisolone 21014 directly affect podocyte structure and function. Thus, the KDIGO recommendation of prescribing daily prednisolone during episodes of upper respiratory infections remains a relevant intervention aimed to reduce the
rituximab 4205 calcineurin inhibitors such as cyclosporine A (CsA) or tacrolimus, mycophenolate mofetil (MMF) and rituximab .It is currently recognized that at least 50% of relapses are triggered by a viral upper respiratory
rituximab 10110 dysregulation of T cells, there is increasing evidence that B cells also play a role given the efficacy of rituximab in treating the disorder [[31]]. Rituximab is a chimeric monoclonal antibody against the CD 20 receptors
rituximab 10858 long after completion of therapy [[34]]. Current evidence from observational studies suggests that rituximab can induce the remission of nephrotic syndrome in patients with membranous nephropathy [[35]-[37]],
tacrolimus 4161 prednisolone, cyclophosphamide, levamisole, calcineurin inhibitors such as cyclosporine A (CsA) or tacrolimus , mycophenolate mofetil (MMF) and rituximab.It is currently recognized that at least 50% of relapses
tacrolimus 9556 sclerosis [[30]]. Immunosuppressive agents such as corticosteroids and calcineurin inhibitors (CsA and tacrolimus ) are known to have direct effects on podocytes through regulation of some cytokines and several signaling
Select Disease Character Offset Disease Term Instance
focal segmental glomerulosclerosis 2998 [[6],[7]]. By contrast, the majority of children with the second most common histological subtype- focal segmental glomerulosclerosis (FSGS) - do not respond to corticosteroids. Only 20% respond to the medication with a high risk of developing
focal segmental glomerulosclerosis 7844 which might result in increased glomerular permeability in patients with minimal change nephropathy and focal segmental glomerulosclerosis [[21]]. Various vascular permeability factors have been implicated including vascular endothelial growth
nephrotic syndrome 54 Title: Italian Journal of PediatricsSteroid-sensitive nephrotic syndrome in children: triggers of relapse and evolving hypotheses on pathogenesisSamuel N UwaezuokePublication
nephrotic syndrome 2568 Children (ISKDC) noted in a report that the vast majority of pre-adolescent children with idiopathic nephrotic syndrome had minimal change nephropathy (MCN) on renal biopsy [[4]]. This histological subtype is the most common
nephrotic syndrome 2701 change nephropathy (MCN) on renal biopsy [[4]]. This histological subtype is the most common cause of nephrotic syndrome in children [[5]]. More than 90% of children with minimal change nephropathy achieve remission with
nephrotic syndrome 2873 minimal change nephropathy achieve remission with oral corticosteroids and thus have steroid-sensitive nephrotic syndrome (SSNS) [[6],[7]]. By contrast, the majority of children with the second most common histological subtype-
nephrotic syndrome 5416 the triggers of relapse, as well as to highlight the evolving hypotheses about the pathogenesis of nephrotic syndrome .Literature search: strategy and outcomeLiterature search was conducted through PubMed, Google web search
nephrotic syndrome 5691 period of six months (July to December, 2014). Using a combination of the following search terms ‘ nephrotic syndrome in children’, ‘pathogenesis’, ‘triggers of relapse’, ‘zinc supplementation’, ‘steroid
nephrotic syndrome 6211 selected. Information was also gathered from textbooks published within the past ten years.Pathogenesis of nephrotic syndrome : evolving hypothesesThe pathogenesis of nephrotic syndrome remains incompletely resolved despite the
nephrotic syndrome 6270 within the past ten years.Pathogenesis of nephrotic syndrome: evolving hypothesesThe pathogenesis of nephrotic syndrome remains incompletely resolved despite the strong evidence of immune dysregulation, mainly involving
nephrotic syndrome 8340 permeability to proteins [[28]].However, recent evidence suggests that the primary defect in idiopathic nephrotic syndrome might be at the level of podocytes (the glomerular visceral epithelial cell). Conventional immunosuppressive
nephrotic syndrome 8639 podocyte structure and function; challenging the “immune theory” of the pathogenesis of childhood nephrotic syndrome and portraying the disease as a ‘podocytopathy’ [[29]]. Injury to the podocyte can indeed occur
nephrotic syndrome 9898 actions thus protect the podocyte against injury and loss resulting in their anti-proteinuric effect in nephrotic syndrome .Although the pathogenic mechanism for nephrotic syndrome has traditionally focused on dysregulation
nephrotic syndrome 9955 resulting in their anti-proteinuric effect in nephrotic syndrome.Although the pathogenic mechanism for nephrotic syndrome has traditionally focused on dysregulation of T cells, there is increasing evidence that B cells also
nephrotic syndrome 10386 variety of neoplastic and immune-mediated disorders [[32]], but was first reported to treat a child with nephrotic syndrome in 2004 [[33]]. In steroid-dependent or resistant cases, partial or complete remission rates of 70-85%
nephrotic syndrome 10896 [[34]]. Current evidence from observational studies suggests that rituximab can induce the remission of nephrotic syndrome in patients with membranous nephropathy [[35]-[37]], MCN [[33],[38],[39]], and FSGS [[40],[41]].Relapse:
nephrotic syndrome 14486 al. [[50]], 100 children aged 1 to 16 years with recently diagnosed idiopathic frequently relapsing nephrotic syndrome were studied and were eligible for therapy with long-term, alternate-day prednisolone (0.5 mg-0.75 mg/kg)
nephrotic syndrome 16331 another prospective study by Mattoo and colleague [[51]], 36 children with steroid-dependent, relapsing nephrotic syndrome were placed on a maintenance alternate-day prednisolone therapy of 0.5 mg/kg. The patients were prospectively
nephrotic syndrome 20166 For more than 5 decades, corticosteroids have remained the mainstay of treatment for children with nephrotic syndrome especially those with MCN although their target cell or mechanism of action in nephrotic syndrome is
nephrotic syndrome 20264 with nephrotic syndrome especially those with MCN although their target cell or mechanism of action in nephrotic syndrome is not clearly understood [[29]]. Nevertheless, the recognition of the crucial role of podocyte injury
nephrotic syndrome 20389 clearly understood [[29]]. Nevertheless, the recognition of the crucial role of podocyte injury in nephrotic syndrome has resulted in many new studies which have identified several important molecular pathways that can
nephrotic syndrome 20740 of drugs which can affect these pathways holds prospects for targeted and effective treatments for nephrotic syndrome in future.The new discoveries however do not preclude the need for the use of immunosuppressive agents
nephrotic syndrome 21392 rates. Prompt search and treatment for UTI should not be overlooked by clinicians managing children with nephrotic syndrome . These relapse-specific interventions can reduce the morbidity associated with frequent relapses and

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