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Nephrosis with minimal glomerular changes, minimal change nephrotic syndrome (MCNS) and focal-segmental glomerulosclerosis (FSGS) are by far the predominant causes of idiopathic nephrotic syndrome (INS). Recently there is an increasing interest in the role of iron in the causation of renal injury and deterioration of renal function in adults and children with nephrotic syndrome. Urinary excretion of Nacetyl--D-glucosaminidase (NAG) may be useful as a marker of tubular dysfunction and damage in idiopathic nephrotic syndrome (INS) which often characterizes steroid-resistant children. The present study was carried out to estimate the level of serum and urinary iron and transferrin to evaluate the effect of their excretion in the development of anemia in nephrotic children, also to clarify the prognostic value of urinary iron according to the histopathological type of the disease. The present work was also devoted to assess the role of immune system in the pathogenesis of idiopathic nephrotic syndrome by determination of serum 2-microglobulin and serum and urinary neopterin. The degree of tubular damage in the most common histopathological types of idiopathic nephrotic syndrome was assessed by estimation of urinary N-acetyl--D-glucosaminidase enzyme (NAG). The study was conducted on 45 children who were grouped as control group and nephrotic children group which was subdivided into two subgroups: minimal-change nephrotic syndrome (MCNS) group and segmental glomerulosclerosis (FSGS) group. The study included fifteen in each group with no significant difference in the mean age and sex between the three studied groups. All children in the study were subjected to thorough history taking, complete physical examination and laboratory investigations which included serum and urinary iron excretion per 24 hours, serum and urinary transferrin excretion per 24 hours, serum ferritin, total iron binding capacity, serum and urinary neopterin excretion per 24 hours, serum 2-microglobulin, urinary N-acetyl--Dglucosaminidase enzyme (NAG) excretion per 24 hours, stool analysis for occult blood to exclude gastrointestinal bleeding and finally renal biopsy was done for all nephrotic children enrolled in the study for histopathological examination. The results of our study showed that idiopathic nephrotic syndrome (INS) is associated with normocytic normochromic anemia despite the increased urinary losses of iron and transferrin. Also, the results of this study showed that both serum neopterin and 2-microglobulin were significantly higher in both nephrotic groups than the control subjects. Serum neopterin level was significantly higher in FSGS group than MCNS Bull. Egypt. Soc. Physiol. Sci. 29 (2) 2009 Abdel-Aleem et al. 132 group with no significant difference of serum 2-microglobulin between MCNS and FSGS groups. It could be concluded that estimation of urinary proteins, urinary iron and urinary NAG could be important for follow up and prediction of the prognosis in children with INS.

Importance of Evaluation of Urinary Iron and Transferrin in the Common Histopathological Types of Idiopathic Nephrotic Syndrome in Children