Nephrotic syndrome in children: the prognostic role of mutagenic factors during pregnancy in mothers
Sancewicz-Pach, K.
Folia Medica Cracoviensia 31(4): 17-49
1990
ISSN/ISBN: 0015-5616 PMID: 2135887 Document Number: 359276
None of the clinical symptoms of the nephrotic syndrome including the age and sex of the sick child as the presence or absence of immunologic markers, and even kidney morphology results explains the fact why in similar situation the course of the nephrotic syndrome in some children is of poor prognosis whereas in others of a good one. The objective of the present study has been to prove that there are additional factors accounting for the course of the obtained remission. The author has had in mind mutagenic factors active during pregnancy in mothers of the children with the primary nephrotic syndrome. An attempt has been made to determine the relationship between the single or multiple occurrence of mutagenic factors and the remission type. The analysis included 250 children with the nephrotic syndrome treated in the years 1965-1985, their age being from 10 months up to 14 years. In the majority of the patients the diagnosis was made on the basis of the clinical picture and laboratory determinations. In 86 cases a renal biopsy was performed. Out of 250 children a complete remission was obtained in 125 cases (50%), and a partial one included 81 patients (32.4%). No remission was observed in 44 children (17.6%). Thirteen patients died (5.2%). The results of the studies have revealed that the presence of selected mutagenic factors e.g. the mother's age over 30 years, maternal diseases and "exposures" noted during pregnancy is closely related to the obtained remission type in the children with the nephrotic syndrome. In the group wherein single factors occurred 48.4% of mothers were over 30 years of age. In the group with two mutagenic factors a combination of maternal diseases and "exposures" was most frequent (52.7%). The mother's age, maternal diseases and "exposures" were the most common combination (73.9%) in the group with three mutagenic factors. The author has noted a positive correlation between the number of mutagenic factors occurring in mothers of the children with the nephrotic syndrome and the obtained degree of improvement. The theoretical likelihood of the lack of remission was increasing with the number of mutagenic factors. The above hypothesis has been confirmed by the relationship between the remission type and the frequency of mutagenic factors incidence in 86 children in whom a renal biopsy was performed. Regardless of the morphologic findings the likelihood of the lack of remission in the children with the nephrotic syndrome increases along with the number of simultaneously acting mutagenic factors.