Analysis of 37 cases of nephrotic syndrome complicated with hypertension in children

Objective To investigate the clinical and pathological features and evaluate the prognosis of nephrotic syndrome with hypertension in children. Methods The clinical and pathological data of thirty-seven children who were initially diagnosed with nephrotic syndrome complicated with hypertension from January 2012 to December 2017 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Based on the renal pathology, the 37 patients were divided into two groups: minimal change disease group (MCD group, n=10) and non-minimal change disease group (non-MCD group, n=27). The therapeutic effect was compared between the two groups, and patients were followed up for observation on prognosis. Results ①Clinical features: compared with MCD group, the level of triglyceride and the incidence of hematuria were higher in the non-MCP group (P 0.05). ②Pathological pattern: non-minor lesions were the predominant type, locating in 27 patients (73.0%), of which 12 cases(44.4%) were focal and segmental glomerulosclerosis (FSGS), 5 cases (18.5%) were IgA nephropathy (IgAN), 4 cases (14.8%) were membranoproliferative glomerulonephritis(MPGN), 3 cases (11.1%) were atypical membranous nephropathy(AMN), 2 cases (7.4%) were IgM nephropathy (IgMN), 1 case (3.7%) was lipoprotein glomerulopathy associated with IgAN; 10 cases(27.0%) were MCD.③ Treatment and prognosis: 32 patients presented with hormone resistance, and the non-MCD lesions were all hormone-resistant. The effect of hormone therapy alone was poor, and combined immunosuppressant was needed. At the end of follow-up, 16 cases (43.3%) were complete remission, 11 cases (29.7%) were partial remission, 5 cases (13.5%) were non-remission, 5 cases (13.5%) developed the end-stage renal disease at an early stage. Conclusions The renal pathological type of nephrotic syndrome in children with hypertension mainly is non-MCD, mostly with steroid-resistence and poor prognosis. When blood pressure is controlled, the renal biopsy should be done earlier in order to better guide the treatment and evaluate the prognosis. Key words: Nephrotic syndrome; Hypertension; Renal biopsy; Children