The most useful drugs in the management of nephrotic syndrome are the corticosteroids. These drugs are as well known for their adverse effects as they are for their therapeutic advantages. The two most common paediatric side effects are suppression of linear growth and posterior subcapsular cataracts. Both of these untoward effects are insiduous and therefore less easily perceived. Although many workers have studied the growth inhibiting effects of the corticosteroids in the various diseases e.g. asthma, very little work was done to investigate these effects in patients with nephrotic syndrome. Furthermore, the Renal Clinic, King Edward VIII Hospital, Durban continues to use a daily regime of prednisone instead of the alternate day regime which is widely recommended to minimise growth retardation. This study was therefore undertaken to investigate the growth inhibiting effects of repeated courses of daily, high-dose prednisone in African and Indian children with nephrotic syndrome. All children with nephrotic syndrome with relevant data in their records and with no other chronic illness were selected from the Renal Clinic. Of the 125 selected, 87 children had been treated with prednisone for an average of 35,9 weeks and 38 had been treated symptomatically. The heights of those that received prednisone were measured at an averace of 77 weeks after completion of therapy. The mean height standard deviation score (SDS) of the treatment and control groups of Indian children were -1,06 and -0,92 respectively, both being between the 10th and 25th percentile, whilst the mean height SDS of the treatment and control groups of African children were -1,82 (just below the 5th percentile) and -1,77 (between the 5th and 10th percentile) respectively. From the results, it is evident that repeated courses of daily prednisone therapy, even when it exceeds 36 weeks, does not inhibit growth in both African and Indian children. Although there was no significant difference between the races and sexes with respect to growth and corticosteroid therapy, this study does confirm earlier reports that most of the African children with nephrotic syndrome had obvious glomerular lesions whilst most of the Indians had minimal change nephrotic syndrome. / Thesis (M.Med.)-University of Natal, Durban, 1986.

O objetivo deste estudo foi analisar o metabolismo ósseo de pacientes com proteinúria glomerular sem uso prévio de drogas que afetassem esse metabolismo. Dezessete pacientes foram estudados com biópsia óssea para análise histomorfométrica e fragmentos ósseos foram obtidos para cultura de célula (n=13) na qual nós avaliamos proliferação de osteoblasto. A comparação dos achados histomorfométricos a controles de literatura demonstrou uma diminuição da remodelação óssea e comprometimento de sua microarquitetura. Corroborando com esse resultado houve diminuição da proliferação dos osteoblastos dos pacientes quando comparados a controles (n=5) doadores de órgãos. Análise bioquímica revelou correlação negativa da 25(OH)D3 com a proteinúria e positiva com a proliferação dos osteoblastos em cultura / The objective of this study was to analyze bone metabolism in proteinuria glomerular patients not having previously used drugs affecting bone metabolism. Seventeen patients were studied with histomorphometric analysis of bone biopsies and bone fragments were obtained for cell culture (n = 13), in which we evaluated osteoblastic proliferation. Comparing patients to controls of literature indicate reduced bone remodeling and altered bone microarchitecture. In corroboration, mean osteoblast proliferation was lower in patient samples when compared with those for normal osteoblasts obtained from age-matched, gender-matched donor organs (n = 5). Concentrations of 25-hydroxyvitamin-D3 correlated negatively with proteinuria and positively with osteoblast proliferation in culture

Le syndrome néphrotique idiopathique (SNI) se caractérise par un remodelage du cytosquelette des podocytes et par une réorganisation des complexes protéiques podocytaires dont le diaphragme de fente. Récemment, une protéine fondamentale dans le remodelage du cytosquelette a été identifiée au niveau des pédicelles : IQGAP1. Nous sommes partis de l’hypothèse selon laquelle IQGAP1 par ses propriétés et ses caractéristiques biologiques connues dans différents modèles cellulaires (protéine d’échafaudage, remodelage du cytosquelette, migration cellulaire) pourrait être fondamentale dans les modifications ultrastructurales observées au cours du SNI. Au cours de ce travail de thèse, nous avons analysé les caractéristiques de la protéine IQGAP1 dans les podocytes humains, son implication dans les fonctions podocytaires et dans la physiopathologie du SNI. Nous avons dans un premier temps caractérisé les propriétés de la protéine IQGAP1 au sein des podocytes et déterminé sa localisation cellulaire à l’interface entre le cytosquelette et les complexes protéiques apical et diaphragmatique. Nous avons démontré le rôle d’IQGAP1 dans la migration podocytaire et dans la perméabilité de la monocouche épithéliale. Ces phénomènes au cours du SNI étant modifiés, nous avons dans un second temps étudié l’implication d’IQGAP1 dans la physiopathologie du SNI à l’aide de différents modèles expérimentaux (aminonucléoside de puromycine, plasmas de patients présentant un SNI, podocytes mutés pour la PLCε1). Nous avons ainsi démontré la translocation nucléaire de la protéine IQGAP1, dépendante de la voie ERK et de la PLCε1 et son implication dans la survie cellulaire par son interaction avec la chromatine. Au cours du SNI expérimental, nous avons observé une modification des propriétés d’IQGAP1 : localisation, interactions, phosphorylation.Cette approche a permis de démontrer l’implication de la protéine IQGAP1 dans le SNI. Compte tenu de son rôle dans le remodelage du cytosquelette, IQGAP1 pourrait également être un facteur dans la genèse de différentes glomérulopathies. / Idiopathic nephrotic syndrome (INS) is characterized by the pedicel cytoskeleton remodelling and the disruption of the slit diaphragm complex. Recently, a pivotal protein involved in cytoskeleton remodelling has been identified in podocytes: IQGAP1.We hypothesized that IQGAP1 may be crucial in ultrastructure changes observed in INS through its biological properties and characteristics reported in different cell types (scaffold protein, cytoskeleton dynamism, cell migration). Thus, we analysed IQGAP1 characteristics in human podocytes, its involvement in podocyte functions and in the INS pathophysiology. We have characterized IQGAP1 podocyte characteristics and clarified its cell localisation between the cytoskeleton and the apical or diaphragmatic protein complexes Our work demonstrated the role of IQGAP1 in podocyte motility and in the permeability of epithelial monolayer. With respect to the modification of these phenomenons during INS, we have studied IQGAP1 involvement in INS pathophysiology with different experimental models (puromycine aminonucleoside, plasmas from patients suffering from INS, PLCε1 mutated podocytes). We have demonstrated IQGAP1 nuclear translocation, dependant to ERK signaling pathway and to PLCε1 and its involvement in cell survival through its interaction with the chromatin. In the experimental INS, we have observed a modification of IQGAP1 properties: localization, interactions, phosphorylation. This approach allowed us to show IQGAP1 involvement in INS. Through its role in cytoskeleton remodelling, IQGAP1 may be a factor in the development of different glomerulopathies.