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Purpose of review
To explore the mechanisms underlying edema formation in nephrotic syndrome. We highlight new methods of volume assessment and a stepwise approach to the management of edema.
Recent findings
New tools are available for intravascular volume assessment. New medications and modalities have been developed for the management of edema....
Citations
... As indicated in Table 1, the eight selected full-text articles consist of four RCTs, 18,19,24,25 one case-control study, 16 a prospective, non-comparative study, 26 a cross-sectional study, 27 and an observational study. 28 The studies were conducted in Iraq 16 and Iran 26,27 and in Asian countries, namely Pakistan, 18,25 Bangladesh, 24 and India. ...
... As indicated in Table 1, the eight selected full-text articles consist of four RCTs, 18,19,24,25 one case-control study, 16 a prospective, non-comparative study, 26 a cross-sectional study, 27 and an observational study. 28 The studies were conducted in Iraq 16 and Iran 26,27 and in Asian countries, namely Pakistan, 18,25 Bangladesh, 24 and India. 19,28 The study settings were all hospital-based. ...
... 19 Other studies documented the participants' mean ages as 6.38 ± 3.42 years, 25 6.5 ± 3.7 years, 26 and 6.2 ± 3.2 years. 27 The majority of the studies reported male predominance 18,24-28 while one study showed a female predominance. 16 In Table 2, the quality assessment of four of the eight studies using the Newcastle-Ottawa Scale shows a star rating of ≥ 7 (high quality) for one study 16 while the remaining studies are rated < 7 (low quality). ...
Introduction
Frequent relapses and steroid dependence are common treatment challenges of steroid-sensitive nephrotic syndrome (SSNS) in children. Acute respiratory infection (ARI) is the most frequently reported trigger of relapse. Given the role of zinc supplementation in preventing ARI, some studies show that this targeted intervention may reduce relapses in childhood SSNS.
Aim
This systematic review aimed to determine if oral zinc supplementation can significantly reduce relapses in this disease.
Methods
We searched the PubMed and Google Scholar electronic databases for interventional and observational analytical studies without limiting their year or language of publication. We selected studies with primary data that met our inclusion criteria, screened their titles and abstracts, and removed duplicates. We used a preconceived structured form to extract data items from selected studies and conducted a quality assessment of randomized controlled trials (RCTs) and non-randomized studies with the Cochrane collaboration tool and the Newcastle Ottawa Scale, respectively. We qualitatively synthesized the extracted data to validate the review’s objective.
Results
Eight full-text articles were selected, comprising four RCTs and four observational analytical studies. Two of the RCTs had a high risk of bias in three parameters of the Cochrane collaboration tool, while three non-randomized studies had low methodological quality. A total of 621 pediatric patients with SSNS were investigated in the eight studies: six participants dropped out in one study. Three RCTs indicate that zinc supplementation may lead to sustained remission or reduction in relapse rate. Similarly, three observational analytical studies suggest a significant relationship between reduced serum zinc levels and disease severity.
Conclusion
Despite the association of zinc deficiency with increased morbidity in SSNS and the reduction of relapse rates with zinc supplementation, there is no robust evidence to recommend its use as a therapeutic adjunct. We recommend more adequately-powered RCTs to strengthen the current evidence.
