Abstract
Background and Aims Nephritic syndrome (NiS) is of significant concern in Pediatric Nephrology with high progression rate. Aim of our study was to establish the pathohistological pattern, and assessment of mofetil mycophenolate efficacy (MMP) in comparison with cyclophosphamide (CYC) in children with NiS. Methods Study was conducted in 27 children (16 boys) with chronic NiS. Kidney biopsy was performed in all patients under US-guidance using biopsy gun. Pathohistological investigation of renal biopsy included: light, immunofuorescent and electron microsopy. Results Most frequent pathohistological variant was IgA-nephropathy (IgA-NP) (74.1%, p<0.001). In 14.8% patients NiS was associated with hereditary nephritis. Membranoproliferative glomerulonephritis (GN) (3.7%), and extracapillary GN (3.7%) were observed rarely. To induce the remission we used IV methylprednisolone for 3–6 days, oral prednisolone (Pred) 60 mg/m²/day, MMP 1 g/m²/day for 3–4 months. Remission was established when proteinuria was decreased to 0.5 g/day. Maintenance therapy was administered for one year or longer. Controls were administered with IV (3–4 pulses) or oral (for 2 months) CYC, Pred 60 mg/m²/day for 1.5–2 months with following alternating schedule. All patients have received ACE inhibitors. Proteinuria was significantly (p<0.05) lower in main group (0.1 g/day) in comparison with controls (0.9 g/day), and GFR increasing was more prominent in main group (from 64.3 to 98.7 ml/min/1.73m2), than in controls (from 68.5 to 89.1 ml/min/1.73m2) (p<0.05). Conclusions Thus, chronic nephritic syndrome in children was mostly associated with IgA-nephropathy. Combination treatment with mycophenolate mofetil + steroids and ACE inhibitors is more effective and safe than cyclophosphamide treatment.