Abstract:

Abstract objective: To investigate the diagnostic criteria of hypoalbuminemia in nephrotic syndrome in children. Methods: Data from children with idiopathic nephrotic syndrome hospitalized in Peking University First Hospital during January of 1993 to December of 2012 were collected and analyzed retrospectively. Children were divided into 2 groups, including a group with serum albumin 25 to 30 g·L^-1 and another group with serum albumin < 25 g·L^-1at onset. Data on children's general information, renal pathology, clinical presentations, treatment, steroid response, serious complications and prognosis were compared between two groups. Results: Data from 458 children were analyzed including 28 cases in group with serum albumin 25 to 30 g·L^-1 and 430 cases in group with serum albumin less than 25 g·L^-1. No significant differences were found in gender and onset age between two groups. ①Twelve children from group with serum albumin <25 g·L^-1 and 141 children from group with serum albumin 25 to 30 g·L^-1 underwent renal biopsy. There was no significant difference in the renal pathological diagnosis type between two groups. Focal segmental glomerulosclerosis was the most common pathological change in both groups. Minimal change disease or minor change disease accounted for 21.9% in group with serum albumin < 25 g·L^-1 and 8.3% in group with serum albumin 25 to 30 g·L^-1. ② There were no significant differences between two groups in the clinical phenotype, the kinds of immunosuppressant, the occurrence of severe complications and the incidence of steroid related adverse events. There was a significant difference in steroid response between the two groups . The steroid response rate was 68.4%（294/430）in group with serum albumin < 25 g·L^-1 and 50.0%（14/28）in group with serum albumin 25 to 30 g·L^-1. ③The occurrence of serious prognosis in group with serum albumin 25 to 30 g·L^-1 was significantly higher than in group with serum albumin < 25 g·L^-1（14.3% vs 4.4%，P=0.04）. Conclusion: Children with heavy proteinuria and serum albumin 25 to 30 g·L^-1 manifested mainly with non minimal /minor change disease and more serious prognosis. Early renal biopsy should be performed on them.