|
 |
Article Review/Hyperlink
|
Webb NJA, Lewis MA, Iqbal J, Smart PJ, Lendon M,
Postlethwaite RJ
Childhood steroid-sensitive nephrotic syndrome: Does the
histology matter?
Am J Kidney Dis
(Apr) 27:484-488 1996

The aim of this study was to investigate 1) The histologic patterns
observed in nephrotic children treated with steroids who became
frequent relapsers (FR) or steroid dependent (SD); 2) The clinical
course of FR and SD children.
Study Design: A retrospective analysis of 51 children who
underwent biopsy prior to initiation of cyclophosphamide therapy for
the causes indicated above and who were followed up for a minimum of 2
years. In addition to the ususal demographic data, the main other
features examined included 1) the distibution of lesions as compared
to what was reported by the International Study for Kidney Disease in
Childhood and by 2 other groups who undertook similar sudies; 2) the
correlation between observed histologic patterns and number and
frequency of relapse prior to biopsy; 3) the correlation between the
frequency of relapse before institution of cyclophosphamide and
response to the latter; 4) the correlation between histologic
diagnosis and duration of remission after cyclophosphamide treatment.
Results: 1) A higher proportion of FSGS cases were found as
compared to the ISKDC; 2) precyclophosphamide course did not
correlate with histology; 3) neither of the last 2 features
correlated with response to cyclophosphamide.
Conclusions: Biopsy is not necessary to decide
whether or not to treat with cyclophosphamide. This decision should
only be based on response to steroids not on the results of biopsy or
the frequency of relapses.
Comment: Webb's paper
compares apples and oranges. As noted by the authors the ISKDC study
biopsied patients at presentation whereas Webb et al. report on a
group of patients who were biopsied before institution of
cyclophosphamide therapy, having been contemplated as a result of the
patients having experienced either steroid dependence or frequent
relapses. It is no surprise that such a group, with less than entirely
satisfactory response to steroids, will include a higher proportion of
cases of FSGS.
The reason the authors' series includes fewer
cases of FSGS than others cited is probably as they pointed out partly
due to the fact that their patients were still biopsied relatively
close to the onset of their disease (8 months vs 6 years). Biopsies
performed years into the course of the disease would be expected to be
less susceptible to the sampling problem inherent in the diagnosis of
FSGS because the kidneys then would have a large proportion of
sclerotic glomeruli. One does not need to evoke the hypothetical and
difficult to prove idea of evolution of minimal change disease over
time to FSGS.
Although the number of cases of FSGS with
complete follow up was small, 5 out of 41 cases only, these few
patients' response to cyclophosphamide seems to have been as
favourable as that of patients with less significant lesions. In our
population we see essentially no prolonged remission following cytoxan
in FSGS.
(Samy S. Iskandar, MBBCh, PhD, Bowman Gray School of Medicine,
Winston-Salem, NC)
Related Folders: |
 |
|
|
|
|