Selectivity Index and Urinary Retinal Binding Protein as Predictors of Steroid Responsiveness in Pediatrics Nephrotic Syndrome

Document Type : Original Article

Authors

Departments of Pediatrics and Clinical Pathology, Cairo University, Egypt.

Abstract

Background: Response to treatment of NS in children can be determined by pathologic diagnosis. Several other non-invasive tests have been tried to predict steroid responsiveness.
Objectives: To evaluate the role of noninvasive estimations of selectively index (SI) and urinary RBP in predicting the response to steroid and the possible pathologic entities, whether minimal change nephrotic syndrome or glomerulonephritis with other histologic patterns and to evaluate the accuracy of calculating 24 hours proteinuria using the spot urinary protein/creatinine ratio, as well as its value in fulfilling the previous purpose.
Methods: In this work leakage of different proteins from the glomerular basement membrane denote by the selectivity index (SI) using immunoglobulin G and transferrin ratio, and in association with tubular dysfunction denoted by urinary retinol binding protein (RBP), were tested in 40 children with nephrotic syndrome (NS) as well as 10 healthy normal children. The patients were 28 steroid responsive (group I) and 12steroid resistant (group II) NS.
Results: SI showed 100% specificity and 43% sensitivity in detecting steroid responsiveness where 43% of group I had SI ˂ 0.18 (range 0.05 – 0.43), and all patients of group II had SI ≥ 0.18 (range 0.18 – 0.93). Meanwhile urinary RBP was ≤ 1.20 mg/L in group I and ≥ 2.54 mg/L in group II, with no overlap indicating more predictivity.
Conclusions: These studied parameters may be used to expect response to treatment and indicate early biopsy for pathologic diagnosis and combined immunosuppressive regimens in those suspected to be steroid resistant.  

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