Evaluation of Urinary Annexin V as a Prognostic Marker in Children with Nephrotic Syndrome

Abstract

The present study aimed to evaluate urinary annexin V as a marker for resistance and prognosis in children with nephrotic syndrome during initial presentation and after remission, in SSNS and SRNS cases. This is a cross sectional in 30 patients with nephrotic syndrome and cohort study evaluation in another 20 patients with newly diagnosed nephrotic syndrome. The patients enrolled from Nephrology Clinic and inpatient wards, Children Hospital, Ain Shams University during the period from November 2013 to April 2014. The NS patients divided into 3 groups: Group I It included 10 males and 5 females. These children suffered from SSNS in remission; their ages ranged from 2 to 13 years with a mean age 7.87±3.68 years. Group II It included 9 males and 6 females. These children suffered from SRNS in remission using other medications; their ages ranged from 2 to 13 years with a mean age is 8.53±3.02 years. Group III This group included 20 newly diagnosed cases of nephrotic syndrome that were followed up from initial presentation for 6-8 weeks and were classified accordingly into SSNS and SRNS. The follow up was continued (beyond 8 weeks) until remission to repeat laboratory work up. They were 12 males (60%) and 8 females (40%), their ages ranged from 2 to13 years with a mean age is 7.45±3.39 years. Those groups were compared to 10 healthy age and sex matched children 6 males (60%) and 4 females (40%). Their ages from 2 to 13 years with a mean age is 8.4±2.91 years as control group. All Subjects included in the study underwent detailed history taking, clinical examination, and routine investigations including complete blood picture, C - reactive protein, erythrocyte sedimentation rate, serum creatinine, serum blood urea nitrogen, total serum proteins, serum albumin and serum cholesterol. They were also subjected to complete urine analysis and quantitative assessment of proteinuria by protein/creatinine ratio. Urinary annexin V level in urinary samples was assessed using sandwich-enzyme-linked immunosorbent assay (ELISA). The above tests was done once in group I, II, IV and twice in group III (initial presentation and in remission). The present study revealed the following results: Urinary annexinV was significantly higher in SRNS than SSNS. During initial presentation, urinary annexinV significantly higher when compared to cases after remission. During initial presentation, urinary annexinV significantly higher when compared to control group. During remission of disease, urinary annexinV significantly higher when compared to control group. Urinary annexinV was significantly higher level in all SSNS patients than control group. Urinary annexinV was significantly higher in all SRNS patients than control group. Serum cholesterol was significantly higher in group II (SRNS) patients when compared to the groupI( SSNS) and control group, Also serum cholesterol was significantly higher in group I SSNS when compared to control group , and serum cholesterol are significantly higher in group III (at initial presentation) when compared to cases after remission and control group. Serum creatinine and BUN did not vary significantly between group I (SSNS), group II (SRNS), group III after follow up (in remission) and control group. On the other hand, serum creatinine and BUN were significantly higher in group III (at initial presentation) when compared to cases after follow up at remission but levels within normal range. A positive significant correlation between urinary annexinV and urinary proteins calculated as urinary protein/ creatinine ratio. In conclusion: In conclusion: Urinary annexinV could be a marker of resistance to steroids in children with nephrotic syndrome.