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Background: Idiopathic membranous nephropathy (IMN) is a rare form of childhood nephropathy. To date there are no standardized protocols of management for this condition in children. The aim of this study is to report on 4 children with IMN who were treated with mycophenolate mofetil (MMF)., Methods: MMF was given in combination with low dose steroids and angiotensin converting enzyme antagonists in a dose of 1,200 mg/m2 body surface area in two divided doses for a minimum of 6 months., Results: All children had histopathological findings in keeping with Stage III membranous nephropathy. At the last hospital visit, 3 children had achieved a > 50% reduction of proteinuria with preservation of renal function. One patient who failed to respond progressed to Stage III chronic kidney disease. None of the children who were treated with MMF experienced any major side effects of the drug., Conclusions: MMF, administered over a limited period, served as a safe and effective immunosuppressive agent in the treatment of this condition, in conjunction with low dose steroids and angiotensin converting enzyme inhibitors. Large multicenter randomized studies of children with IMN are necessary to assess the efficacy and long term safety of MMF.

Background: Indications for peritoneal dialysis in children with post-dysenteric hemolytic uremic syndrome (D+ HUS) have not been thoroughly evaluated. Although early institution of dialysis may reduce mortality, the procedure has attendant complications., Aim: To determine whether the use of more stringent criteria for instituting dialysis had a better outcome to that of using conventional criteria., Method: Following an outbreak of Shigella dysenteriae type 1 D+ HUS in KwaZulu/Natal during June 1994 to October 1995, we compared the renal outcome and mortality between two periods: before May 1995 (69 children) when conventional criteria for dialysis were employed and after May 1995 (70 children) when more stringent criteria for dialysis were applied., Results: The mean age of presentation was 35 months, 79 (56.8%) were males. Both groups were comparable except for gut perforation, which was more frequent before May 1995, and hypertension and severe disease, which were more frequent after May 1995. Seventy patients underwent dialysis, 36 (52.2%) before May 1995. There were no significant differences in renal outcome or death following discharge from hospital in both groups. Overall mortality was 20.1%, 15 (53.6%) of the 28 children that demised presented before May 1995., Outcome: Accordingly, although children with more severe disease and a higher frequency of hypertension presented after May 1995, there were no significant differences in morbidity or mortality in those using stringent criteria for dialysis, compared to those in whom conventional criteria were used., Conclusion: We showed that several children, who would previously have been dialyzed, may be managed conservatively, without an increase in mortality or morbidity.

Aim: The aim of this paper was to describe the clinical course, histological grading, response to therapies and complications of nephrotic children with focal segmental glomerulosclerosis (FSGS) in Durban, South Africa., Methods: The demographic data, response to drug therapy, complications, renal function and disease status at the last hospital visit were recorded in children diagnosed as FSGS on histology. Biopsies were graded according to the degree of glomerulosclerosis and interstitial involvement., Results: Seventy-five children, 32 Indian and 43 Black were studied. FSGS as a proportion of all children seen with nephrotic syndrome, has risen between 1970 to 1995 from 1.8% to 20% in Indian children and 5% to 28% in Black children. Of those children followed for two years or more, the two racial groups were similar with respect to age at presentation, gender, histological grading, hypertension, renal outcome and response to therapies except for cushingoid features (p < 0.7), alopecia (p < 0.003) and respiratory tract infections (p < 0.001) which occurred more frequently in Indian children. Forty-three children were followed for between 2-16 years: 14 (10 Indian and 4 Black (p < 0.5)) (29%) had grade 1 changes, 24(13 Indian, 11 Black (p < 0.98)) (56%) had grade 2 changes, 3 (Indian (p < 0.26)) (7%) had grade 3 changes and 2 (Black (p < 0.17)) grade 4 changes. Over this period 27 (63%) had normal renal function, 6 (14%) died, 4 (9%) developed impaired renal function, 6 (14%) chronic renal insufficiency and 6 (14%) end-stage renal disease. Three of the latter were transplanted. At the last hospital visit, Indian children had remitted more often (p < 0.6) and Black children suffered relapse more frequently (p < 0.03). Two children had spontaneous disease remission, and 5 had sustained remission following a course of prednisolone and/or cyclophosphamide., Conclusion: This, one of the largest studies of FSGS in children, shows a marked rise in this condition and some differences between Indian and Black children. The outcome in Black children was not as poor as anticipated.