engleski

Albumin-Bilirubin (ALBI) grade among children with steroid sensitive and resistant nephrotic syndrome: could the initial values forecast the outcome?

Introduction: Despite the wide use of steroids for idiopathic nephrotic syndrome (INS) treatment during the past 60 years, the reliable marker of response is still lacking. Recently, a parameter known as the albuminbilirubin (ALBI) grade has been used in several malignant, infectious, and immune-mediated diseases to predict the prognosis and response to treatment. Material and methods: This was a single centre retrospective pilot study investigating the ALBI grade in children with non- genetic INS. Both albumin and bilirubin concentration were measured before the standard steroid regime was commenced, while patients were further divided according to response during ≤6 weeks of treatment. The ALBI grade was calculated based on the formula previously reported in the literature (log10 bilirubin [μmol/L] × 0.66) + (albumin [g/L] × −0.0852). Results: Total of 18 responders and 6 non- responders were included, with the mean age of 6.14 and 6.02 years, respectively. The average ALBI score was -1, 31 for responders and -1, 14 for non-responders. Conclusions: The crucial role of the immune system in the pathogenesis of non-genetic INS has been widely accepted in recent years, although the precise mechanisms remain inconclusive, and most probably multifactorial. Consequently, a possible systemic subclinical inflammation involving the liver might contribute to the underlying disease processes. In this context, the albumin and bilirubin might be further explored beyond their mechanical role in the maintenance of oncotic pressure, as a negative marker of inflammation and liver damage. Therefore, despite the lack of statistical significance, most probably due to a small number of patients, the result of our study indicates that the ALBI grade, highly representative of the complex albumin and bilirubin interactions, might have a value as a marker of outcome in INS.

nephrotic syndrome ; albumin-bilirubin grade ; children

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