Vol. 7, Issue 1, Part A (2025)

Background: One of the greatest chronic kidney diseases that are prevalent in childhood is the idiopathic nephrotic syndrome (INS). It is marked with huge proteinuria, hypoalbuminemia, hyperlipidemia and edema. In the active disease, the loss of the essential proteins in the urine of the immune system, coagulation, and renal homeostasis puts the affected children at risk of severe complications, such as infection, thromboembolism, and acute renal failure.
Aim: To evaluate biochemical and hematological parameters and compare their variations among different clinical types of nephrotic syndrome in pediatric patients attending selected hospitals in Baghdad, Iraq.
Patients and Methods: Prospective observational study. The sample consisted of 74 patients younger than 14 years with nephrotic syndrome who were admitted to the departments of nephrology of Al-Imammain Al-Kadhymain Medical City and Baghdad Medical City between December 1, 2023, and August 31, 2024. An interviewer-administered questionnaire, detailed clinical assessment, and laboratory studies were taken as the data collection methods.
Results: The average age of presentation was 6.57 years with a standard deviation of 3.44 and the average age at the onset of the disease was 4.3 years with a standard deviation of 2.57. The most frequent type was frequently relapsing nephrotic syndrome (FRNS) (42 children, 56.76%), then there were newly diagnosed cases (20 children, 27.03%), infrequently relapsing nephrotic syndrome (IRNS) (9 children, 12.16%), and steroid-resistant nephrotic syndrome (SRNS) (3 children, 4.05%). Mean age of children with IRNS was much greater (9.2±4.2 years) than newly diagnosed ones, FRNS, and SRNS (p = 0.030). Age at onset was much greater in newly diagnosed patients than in FRNS and SRNS samples (p = 0.010). Among children with SRNS, the lowest serum albumin (1.23±0.06 g/dL) and total serum protein (3.03±0.47 g/dL) were found, and their levels were significantly different than others (p = 0.014 and p = 0.038, respectively). The levels of serum urea and creatinine were normal in all groups. The total cholesterol level was significantly higher in SRNS (456±135.47 mg/dL) than in FRNS (p = 0.043). There was a significant difference in hemoglobin levels in FRNS and newly diagnosed cases (p = 0.049). Mean partial thromboplastin time (PTT) was significantly reduced in SRNS as compared to IRNS (p = 0.044), but PT and INR were in normal range..
Conclusion: The nephrotic syndrome occurring at a young age seems to be linked with a higher risk of developing steroid-resistant disease. SRNS has a more serious type of hypoalbuminemia and a decrease in total serum protein. Platelet count remained high in all forms of nephrotic syndrome, and coagulation parameters were mostly normal with mild changes in PTT only in IRNS.