Randomized controlled trial on immunomodulatory effects of azithromycin in children with steroid-dependent nephrotic syndrome

Sawires, Happy; Abdelaziz, Hanan; Ahmed, Heba Mostafa; Botrous, Osama; Agban, Michael N.

doi:10.1007/s00467-019-04251-5

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…The present study shows the mean age of the patients was 5.42±2.67 years of which males were 67.6% and females were 32.4%. Another study by Sawires et al, [13] found the mean age of the patient was 8.42±1.5 years which was relatively higher than this study cause may be due to their study of children being steroiddependent NS only. Another study done by Esezobor, Solarin, and Gbadegesin et al, showed that the mean age of childhood NS is 5.1 years and this mean age is almost similar to the present study [14].…”

Section: Discussioncontrasting

confidence: 68%

Sociodemographic, Clinical & Biochemical Features in Children with Nephrotic Syndrome: A Study in a Tertiary Care Hospital of Bangladesh

Uddin,

Khan,

Alam

et al. 2024

Sch J App Med Sci

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Background: The estimated incidence of nephrotic syndrome is between 2-7 per 100,000 children worldwide, with higher rates reported among those with African and South Asian ancestry. There is a significant gap in the literature on the role of socio-demographic modifiers of nephrotic syndrome in children in the long term. This study aimed to evaluate the sociodemographic & clinical features in children with nephrotic syndrome. Methods: This descriptive study was conducted at the Department of Pediatric Nephrology in the National Institute of Kidney Diseases & Urology (NIKDU), Sher-E-Bangla Nagar, Dhaka, from November 2019 to June 2021. Children of age group 1-12 years with primary NS enrolled in this study and a total of 108 patients were included. Informed written consent was taken from the parents. Ethical clearance was obtained from the institutional ethical committee. A purposive sampling technique was used in this study. On entry into the study, a detailed history was taken & proper physical examinations were done. Routine investigations such as complete blood count, CRP, serum albumin, serum cholesterol, serum creatinine, Mantoux test, screening tests for hepatitis-B & hepatitis-C, urine RME and culture sensitivity, X-ray chest, and serum C3 level were done. All investigation was done from NIKDU except the MT test that was done from Dhaka Shishu Hospital. Infection was screened out and appropriate measures were taken. The data were collected and preserved in a case record form (CRF). The collected data were analyzed using Statistical Package for Social Sciences (SPSS) software, version 23.0. Results: The majority of the patients (50, 46.29%) were 5 to 8 years old, followed by (40, 37.03%) 1-4 years old. Mean ±SD 5.42±2.67. Most of the patients (73, 67.6%) were male and the rest (35, 32.4%) were female, the majority (71%) belonged to rural areas. Regarding socioeconomic status, the majority of the patients (80, 74.08%) belonged to low-income families. .......

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Section: Discussioncontrasting

confidence: 68%

Sociodemographic, Clinical & Biochemical Features in Children with Nephrotic Syndrome: A Study in a Tertiary Care Hospital of Bangladesh

Uddin,

Khan,

Alam

et al. 2024

Sch J App Med Sci

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“…Before commencing rituximab in case 2, AZM was given in conjunction with corticosteroids for 5 months. Randomized controlled trials have reported a significantly lower relapse rate in SDNS children treated with AZM and corticosteroids, compared with corticosteroids alone [ 30 , 31 ]. Moreover, Hara and Hirano [ 32 ] reported that a 2-year-old boy with FRNS treated with AZM achieved a relapse-free period of 1 year.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Rituximab, Mycophenolic Acid, and Calcineurin Inhibitors Achieve Long-Term Remission in Pediatric Focal Segmental Glomerulosclerosis with Steroid-Resistant and Frequently Relapsing Nephrotic Syndrome: A Report of Two Cases

Ambarsari

Saraswati

Laudza

2022

Case Rep Nephrol Dial

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Studies investigating the effect of rituximab in children with nephrotic syndrome (NS) due to focal segmental glomerulosclerosis (FSGS) have reported conflicting results, with some concluding that patients may require additional immunosuppressive therapy to achieve and/or maintain long-term remission. We report successful treatment of pediatric FSGS with rituximab infusions, followed by maintenance immunosuppression with mycophenolic acid (MPA) and a calcineurin inhibitor (CNI) in 1 patient with refractory steroid-resistant NS (SRNS), and one with frequently relapsing NS (FRNS). Case 1 is a patient with refractory SRNS due to FSGS. MPA and tacrolimus induced complete remission within 6 months following rituximab treatment. Remission was maintained for over 2 years, and the patient’s kidney function and body height also returned to normal ranges within this time. Case 2 is a patient with FRNS due to FSGS, who was treated with rituximab followed by MPA and cyclosporine, which successfully prevented relapses for 18 months, that is, at the end point of the observation. Our case report demonstrates that rituximab and a combination of CNIs and MPA can be effective in achieving complete remission in pediatric refractory SRNS and sustaining remission in pediatric FSGS with FRNS and SRNS for several years. This treatment regimen has the advantage of eliminating the need for long-term high-dose steroid treatments, allowing 1 patient to achieve normal growth and recover from other adverse steroid effects.

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“…Most children with SRNS will progress to end-stage renal disease (ESRD) within 5 to 10 years after diagnosis 1. Although steroid treatment remains the mainstay therapy for patients with SDNS/FRNS, prolonged glucocorticoid treatment is associated with significant morbidity, as many immunosuppressive agents are used to reduce the glucocorticoid dosage and side effects 2. According to genomic studies conducted in the last 20 years, most cases of refractory nephrotic syndrome are likely due to genetic variants that cause structural and functional defects in the glomerular visceral epithelial cell, and the clinical and pathological phenotypes of each subgroup are tightly linked to the genetic phenotypes 3–5…”

Section: Introductionmentioning

confidence: 99%

Relationships between the clinical phenotypes and genetic variants associated with the immunological mechanism in childhood idiopathic nephrotic syndrome: protocol for a prospective observational single-centre cohort study

et al. 2019

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IntroductionIdiopathic nephrotic syndrome (INS) is the most common glomerulopathy that results in childhood chronic kidney disease in China, but the relationships between different clinical phenotypes and immunological genetic variants observed in patients with INS are ambiguous and have not been well studied. A cohort study combined with whole exome sequencing might further identify the effects of immunological genetic variants on clinical phenotypes and treatment outcomes.Methods and analysisWe describe a 3 year prospective observational single-centre cohort study to be conducted in the Children’s Hospital of Chongqing Medical University in China. This study will recruit and investigate 336 patients with childhood-onset INS presenting with different clinical phenotypes. Whole exome sequencing will be conducted when patients progress to a confirmed clinical phenotype during follow-up. Relevant clinical and epidemiological data, as well as conventional specimens, will be collected at study entry and 1 month, 3 months, 6 months, 1 year, 2 years and 3 years after disease onset. After this cohort is generated, the immunological genetic variants of steroid-sensitive nephrotic syndrome without frequent relapse, steroid-resistant nephrotic syndrome and steroid-dependent/frequent relapse nephrotic syndrome will be evaluated.Ethics and disseminationThe study protocol is approved by Ethics Committee of Children’s Hospital of Chongqing Medical University (reference number 2018–140). The results will be disseminated through peer-reviewed journals and conference presentations.Trial registration numberChiCTR1800019795

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Randomized controlled trial on immunomodulatory effects of azithromycin in children with steroid-dependent nephrotic syndrome

Cited by 7 publications

References 25 publications

Sociodemographic, Clinical & Biochemical Features in Children with Nephrotic Syndrome: A Study in a Tertiary Care Hospital of Bangladesh

Sociodemographic, Clinical & Biochemical Features in Children with Nephrotic Syndrome: A Study in a Tertiary Care Hospital of Bangladesh

Rituximab, Mycophenolic Acid, and Calcineurin Inhibitors Achieve Long-Term Remission in Pediatric Focal Segmental Glomerulosclerosis with Steroid-Resistant and Frequently Relapsing Nephrotic Syndrome: A Report of Two Cases

Relationships between the clinical phenotypes and genetic variants associated with the immunological mechanism in childhood idiopathic nephrotic syndrome: protocol for a prospective observational single-centre cohort study

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