ESPN 51th Annual Meeting

ESPN 2018


 
MEMBRANOUS NEPHROPATHY IN CHILDREN: A RETROSPECTIVE OBSERVATIONAL MULTICENTRE STUDY IN TURKEY
IBRAHIM GOKCE 1 MEHTAP SAK 1 MERAL TORUN BAYRAM 2 OZLEM AKSOY 3 ENGIN MELEK 4 ZEYNEP NAGEHAN YURUK YILDIRIM 5 DEMET TEKCAN 6 AYSE SEDA PINARBASI 7 EREN SOYALTIN 8 NILUFER GOKNAR 9 ERKIN SERDAROGLU 10 GUL OZCELIK 11 HULYA NALCACIOGLU 12 SEBAHAT TULPAR 13 NESE OZKAYIN 14 ELIF BAHAT OZDOGAN 15 PELIN ERTAN 16 NECLA BUYAN 17 OZLEM AYDOG 6 UMUT SELDA BAYRAKCI 3 AYSUN KARABAY BAYAZIT 4 ALPER SOYLU 2 SALIH KAVUKCU 2 ALEV YILMAZ 5 ALI ANARAT 18

1- MARMARA UNIVERSITY MEDICAL SCHOOL DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- DOKUZ EYLUL UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
3- ANKARA PEDIATRIC HEMATOLOGY AND ONCOLOGY RESEARCH AND TRAINING HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
4- CUKUROVA UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
5- ISTANBUL UNIVERSITY ISTANBUL MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
6- SAMSUN 19 MAYIS UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
7- ERCIYES UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
8- IZMIR TEPECIK RESEARCH AND TRAINING HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
9- ISTANBUL BAGCILAR RESEARCH AND TRAINING HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
10- IZMIR DR. BEHCET UZ PEDIATRIC DISEASES AND SURGERY RESEARCH AND TRAINING HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
11- SISLI ETFAL RESEARCH AND TRAINING HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
12- KAYSERI RESEARCH AND TRAINING HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
13- BAKIRKOY SADI KONUK RESEARCH AND TRAINING HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
14- TRAKYA UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
15- KARADENIZ TECHNICAL UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
16- CELAL BAYAR UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
17- GAZI UNIVERSITY MEDICAL SCHOOL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
18- MEMORIAL ATASEHIR HOSPITAL, DEPARTMENT OF PEDIATRIC NEPHROLOGY
 
Introduction:

Idiopathic membranous nephropathy(IMN) is one of the most common cause of adult nephrotic syndrome(NS), but occurs less frequently in children. Here, we aimed to evaluate the clinical features and identify risk factors predicting outcome of children with MN in our cohort.

Material and methods:

We analyzed the medical records of the 45 biopsy-proven MN patients retrospectively from 17 pediatric nephrology units in Turkey.

Results:

The 45 patients with MN included 24(53.3%) girls and 21(46.7%) boys, with the median age of 12(range 1.5 to 20 ) years old at the time of hospital admission. Of these 45 patients, 36 had IMN, 2 de nova MN in renal transplants and 7 secondary MN. The causes of secondary MN were: 3 hepatitis B virüs infection, 2 systemic lupus erythematosus, 1 dermatomyositis and 1 diabetes mellitus. Six(13.3%) patients had an estimated glomerular filtration rate(eGFR) lower than 90 ml/dk/1.73 m2 at diagnosis. Thirty-seven(82.2%) patients presented with nephrotic range proteinuria and the mean albümin level was 2.43±0.97 g/dl. The median follow-up duration was 36(range 2 to 192) months. Renin-angiotensin-aldosterone system(RAAS) blockades, calcium channel blockers and statins were used for conservative management in 31(86.1%), 2(5.5%) and 5(13.8%) patients with IMN, respectively. Conservative treatment comprised RAAS blockades and other non-immunosuppressive agents were applied to 3(8.3%) patients. Although immunosuppressive regimens were not uniform, 33(91.7%) patients were treated with immunosuppressive drugs. Remission was achieved in 39(86.6%) patients. Nine(23.1%) patients experienced relaps of proteinuria. At the last follow-up visit, 35(77.7%) patients were still in remission. When we compare remitted and non-remitted groups, eGFR at admission was found to be significantly higher in remitted group, 172.97±77.36 ml/dk/1.73 m2 than non-remitted group, 118.00±31.76 ml/dk/1.73 m2, p:0.014. 

Conclusions:

The majority of children with MN in this cohort were found to have a good prognosis with high remission rate. Decreased eGFR at baseline was associated with non-achievement of remission.