Grant: Project Grant

Nephrotic syndrome is the most common acquired kidney disease in children. It is caused by massive leakage of protein from blood into urine, leading to significant body swelling. Body swelling and complications lead to frequent clinic visits and hospitalizations, all contributing to a substantial burden on patients, families, and the health care system. Most children with nephrotic syndrome get better after taking treatments that dampen the immune system like prednisone (a steroid, thus 'steroid sensitive'). However, approximately ~20% of children will not get better after prednisone (thus 'steroid resistant') and may progress to kidney failure. They can experience significant complications along the way, such as blood clots, and infections. It is currently impossible to predict who will respond to treatments, and what will be the patients' clinical course. Further, who gets better with drug treatment varies by ancestry, and the disease affects males slightly more than females. The current treatment approach for nephrotic syndrome is a 'one size fits all' strategy without changing treatment to fit the person with the illness, often causing a frustrating experience for patients and families. Clinicians will treat using prednisone (a non-specific immune suppressing drug) for several weeks before a response, and continue to treat with prednisone over several episodes, before being able to provide any prognostic information to the patients and families. Our proposed work aims to increase our understanding of the clinical course and treatment outcomes of patients with steroid sensitive nephrotic syndrome using careful clinical data collection, evaluation of outcomes, and evaluation potential immune based biomarkers (specific immune cells in the B cell pathway and antibodies to proteins in the kidney filters) to see if these markers can be helpful to predict clinical course.