Nephrotic syndrome is defined as Oedema; nephrotic range proteinuria (>40 mg/m²/h on timed sample, spot albumin to creatinine ratio >2 mg/mg); hypoalbuminaemia (<2.5 g/dl) ( Srivastava, Jaypee; 2005 p. 159-200)
Nephrotic syndrome is a chronic disorder, differentiated by alterations of permselectivity at the glomerular capillary wall, as a result of this it fails to restrict the urinary loss of protein. Nephrotic range proteinuria is defined as proteinuria exceeding 1000 mg/m² per day or the spot (random) urinary protein-creatinine ratio exceeding 2 mg/mg. The proteinuria in childhood nephrotic syndrome is quite selective, constituted primarily by albumin.
Annually 2-7 per 100,000 children suffer from nephritic syndrome, and prevalence among them ranges from 12-16 per 1000001. There is strong evidence that nephritic syndrome is found much more in children from south Asia. The patient is usually in their primary stages, in 95 per cent cases. However, there are also a underlying disorders that might be identified in less than 5 per cent of cases that is: systemic lupus erythematosus, Henoch Schonlein purpura, amyloidosis and infection with HIV, parvovirus B19 and hepatitis B and C viruses1, 3, 4
Another characteristic of such patients is that more than 80 per cent with nephritic syndrome show minimal change disease (MCD), with normal renal histology on light microscopy. The rest of which is attributed to focal segmental glomerulosclerosis (FSGS) and mesangioproliferative glomerulonephritis (MesPGN)
The pathogenesis of MCD is not fully known, however strong evidence of immune dysregulation, with cell-mediated immunity (CMI) is present. The possibility of a relapse of the nephrotic syndrome after any viral infections or an atrophic episode is strongly present. This can be said because of the association with HLA antigens and Hodgkin’s lymphoma, and the therapeutic response to steroids and cyclosporine A (CsA)................
