Incidence and predictors of relapse among children with nephrotic syndrome at Assosa zone hospitals, Benishangul Gumuz Region, Northwest Ethiopia, 2022

Abstract

BackgroundRelapse is the major problem in children with nephrotic syndrome and leads to a substantial burden on the patient and family worldwide, particularly in resource-limited countries like Ethiopia. However, little is known about the incidence of relapse and its predictors among children with nephrotic syndrome in the study area.MethodsAn institution-based retrospective follow-up study was conducted among 354 randomly selected nephrotic syndrome patients admitted from April 2017 to March 2022. Data entry was carried out using Epi-data manager version 4.6.0.6 and Stata software version 14 for data cleaning and analysis. Cox-proportional hazard models were used to identify predictors of relapse. Any variable with a p-value < 0.25 in the bivariable was taken into the multivariable analysis, and then the association and statistical significance were declared at P≤ 0.05.ResultsMore than half, 55.8% (82/147), of relapses were recorded in the first six months of follow-up. The incidence of relapse was 82.3 per 1000 child-month-observations, with an overall risk of 1785.9 child-month-observations. In children with nephrotic syndrome, the presence of wasting malnutrition [AHR = 1.93, 95% CI 1.28–2.90], acute respiratory tract infections [AHR = 1.79, 95% CI 1.19–2.71], elevated triglyceride levels [AHR = 2.74, 95% CI 1.48–5.07], and low serum albumin levels [AHR = 4.34, 95% CI 22.18–8.64] were predictors of relapse.Conclusion and RecommendationsThe incidence of relapse among nephrotic syndrome patients was high. The independent predictors of relapse in children with nephrotic syndrome were the presence of acute respiratory tract infections, wasting malnutrition at admission, low serum albumin levels, and elevated serum triglyceride levels. Therefore, intervention to reduce and control earlier relapse should focus on preventing relapse-related complications.