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Journal of the Korean Society of Pediatric Nephrology 2001;5(2): 136-146.
스테로이드에 반응을 보인 신증후군 환아에서 재발 예측인자로서 고지혈증의 중요성
정순필, 홍순철, 임성준, 임인석, 최응상
1중앙대학교 의과대학 소아과학교실
2중앙대학교 의과대학 소아과학교실
3중앙대학교 의과대학 소아과학교실
4중앙대학교 의과대학 소아과학교실
5중앙대학교 의과대학 소아과학교실
The Significance of Hyperlipidemia as a Predictive Factor of Relapse in Corticosensitive Nephrotic Syndrome
Soon-Pil Jung, Soon-Cheul Hong, Seong-Joon Lim, In-Seok Lim, Eung-Sang Choi
1Department of Pediatrics, Chung-Ang University College of Medicine
2Department of Pediatrics, Chung-Ang University College of Medicine
3Department of Pediatrics, Chung-Ang University College of Medicine
4Department of Pediatrics, Chung-Ang University College of Medicine
5Department of Pediatrics, Chung-Ang University College of Medicine
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ABSTRACT
Purpose : One of the most difficult problems in the care of children with nephrotic syndrome remains the occurrence of relapses, despite initial response to steroids. Constantinescu reported that rapidity of initial response to steroid therapy could predict fewer relapses in the first year. So we evaluated the changes in serum lipid abnormalities in children with corticosensitive nephrotic syndrome before steroid treatment and the correlation between serum lipid levels and renal function, days to remission. Methods . We analyzed the Medical records of children who were managed by us between October 1994 and August 2000. In 33 patients with corticosensitive nephrotic syndrome, we evaluated the correlation between serum lipid levels and renal function [Creatinine clearance(Ccr)] and proteinuria before steroid treatment, and days to remission defined as the third day when the patient's urine becomes protein free.
Results : There were 21 males and 12 females. Median age at presentation was 6.4 years (range: 1.8-17.3 years). Median days to remission were 15.4 days (range 4-42 days) on Prednisolone $60mg/m^2$ daily. The increased levels of triglyceride, total cholesterol, LDL cholesterol, apolipoprotein B, total cholesterol/HDL cholesterol, Lipoprotein(a) were observed. But the level of HDL cholesterol was not increased. Serum albumin was decreased a]id proteinuria was increased before steroid treatment. But Ccr was not decreased. There were negative correlation between serum albumin and total cholesterol (r = -0.5157, P<0.005), LDL cholesterol (r = -0.5543, P<0.005), total cholesterol/HDL cholesterol (r = -0.4506, P<0.01), lipoprotein(a) (r = -0.4570, P<0.025), apolipoprotein B (r = -0.5297, P<0.025), apolipoprotein B/apolipoprotein Al (r = -0.5851, P<0.01), apolipoprotein B/HDL cholesterol (r = -0.4961, P<0.05) before steroid treatment. There was no correlation between proteinuria and serum lipid profiles. Also Ccr and serum lipid profiles were not correlated. There was positive correlation between days to remission and HDL cholesterol (r = +0.4511, P<0.05), apolipoprotein B (r = +0.5190, P<0.05), apolipoprotein B/HDL cholesterol (r = +0.7169, P<0.005).
Conclusions : This results reveal that HDL cholesterol, apolipoprotein B and apolipoprotein B/HDL cholesterol can be used as a predictive factor in corticosensitive nephrotic syndrome. We could not determine the significant level of these lipids for insufficient patients number, but these level may predict future relapses of corticosensitive nephrotic syndrome patients and thus may allow to better management and treatment protocols. More data and long term follow up studies should be needed. (J Korean Soc Pediatr Nephrol 2001;5 : 136-46)
Key words: Hyperlipidemia | Nephrotic syndrome | Predictive factor | Relapse | Remission | Steroid
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