Case of steroid-sensitive nephrotic syndrome in a child with orphan disease – leucinosis.

Abstract

BACKGROUND.  The article presents the case of a clinical and laboratory complex of a recurrent hormone-sensitive variant of nephrotic syndrome in a patient with leucinosis (maple syrup disease). THE AIM: to study the clinical laboratory features of nephrotic syndrome in a child with orphan disease – leucinosis. A PATIENT. A 4-year-old child born in a consanguineous marriage, who had previously been diagnosed with a rare genetic disease leucinosis, was examined. The manifestation of leucinosis began from the 8th day of birth. Based on the results of a molecular genetic study the diagnosis was pinpointed as leucinosis with an autosomal recessive mode of inheritance, classic neonatal (maple syrup disease). At the age of 4 the child developed a clinical and laboratory complex of nephrotic syndrome. RESULTS.  The onset of nephrotic syndrome was characterized by a hormone-sensitive course. After completion of the course of glucocorticosteroid therapy, there was a relapse because of acute respiratory infection which also turned out to be hormone-sensitive. Kidney function was not impaired. There were no crises of leucinosis due to nephrotic syndrome. CONCLUSION. Taking into account the development of nephrotic syndrome in a child with a genetically determined disease, a molecular genetic examination should be done to exclude the hereditary nature of the developed nephrotic syndrome. The examination is of great clinical importance for determining treatment tactics, cytostatic therapy, doing a kidney biopsy in order to determine the morphological form of glomerulonephritis, prognosis of progression to the end-stage renal failure.