Predicting First-Year Relapses in Children With Nephrotic Syndrome

Constantinescu, Alexandru; Shah, Hetal B.; Foote, Edward F.; Weiss, Lynne

doi:10.1542/peds.105.3.492

Cited by 70 publications

(55 citation statements)

References 13 publications

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“…It was shown in a similar study that prognosis would be better in children going into early remission with steroid medication. [13] Infectious episodes in nephrotic patients are responsible for high morbidity and can also cause an inadequate response to corticosteroid therapy and recurrences among patients in remission. [14] In our patients, similar to the frequency of having infection, frequency of relapse has increased significantly (r=0.44; p = 0.001).…”

Section: Discussionmentioning

confidence: 99%

Steroid Responsiveness of Children with Idiopathic Nephrotic Syndrome in Southeastern Region of Turkey

et al. 2007

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Background. Our aim was to determine the prognostic factors effective in the response to steroid treatment and relapse frequency. Patients and Methods. In this study, we evaluated 84 children with idiopathic nephrotic syndrome followed-up from 1997-2002. The variables were analyzed with respect to medical history, physical examination, laboratory findings, response to treatment, and factors associated with remissions and relapses. Our study group consisted of 62 children with minimal change nephrotic syndrome (MCNS), 11 children with focal segmental glomerulosclerosis (FSGS), and 11 children with diffuse mesangial proliferation (DMP). Results. According to response to steroids; 57.1% were steroid-sensitive with infrequent relapses, 22.6% were steroid-dependent with frequent relapses, and 20.2% were steroid-non-responders. Significantly high non-responder ratios to steroids were found in children with initial hypertension and hematuria (p < 0.05). Although patients older than six years were found to be associated with steroid nonresponse (p < 0.05), the number of relapses were found to be increased with an increasing number of infections (p < 0.05). The time period for the first relapse was found to be statistically correlated with relapse numbers of the first 6 (p = 0.001) and 12 (p = 0.01) months. Conclusion. The time span between initial presentation and remission and the number of infections were significant for relapse frequency. The existence of hematuria and hypertension and age greater than 6 years at initial presentation were associated with steroid non-responsiveness. The likelihood of developing resistance to the treatment should be emphasized early to the parents of patients bearing these risk factors, and hence the possible disappointment in the family should be prevented.

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Section: Discussionmentioning

confidence: 99%

Steroid Responsiveness of Children with Idiopathic Nephrotic Syndrome in Southeastern Region of Turkey

et al. 2007

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“…T he annual incidence of idiopathic nephrotic syndrome (INS) in children is 2-7 /100,000 populations below 1-16 years of age 1 . The patients are usually treated with oral prednisolone as per APN protocol (prednisolone 60 mg/m 2 /day for 6 weeks, followed by 40 mg/m 2 /every alternate days for 6 weeks) 4 .…”

Section: Introductionmentioning

confidence: 99%

“…The relapses are often precipitated by infections 6,9,14 which become troublesome for the patients as well as parents. Certain factors such as age, gender, time to response, duration of treatment of initial episode and frequency of relapses in the initial six months have been found to predict the relapses in these patients 1,10,16 . However, there has been inconsistency in the literature and also paucity of reports from our country to determine precisely that which factors are really responsible for, and reliably predict the relapses.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Predictors of Relapse in Children with Steroid Sensitive Nephrotic Syndrome

Bhatta

Shah

Mishra

2017

J. Nepal Paedtr. Soc.

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“…The records of 125 children with steroid responsive INS were retrospectively studied; out of which 38 children (23.4 %) were steroid dependent. It was found that time duration of remission (<10 d) from start of therapy (p 0.00, OR= 1.1, 95 % CI=1.0-1.1) and steroid regime other than 6 wk daily (2 mg/kg)+6 wk alternate day (1.5 mg/kg) (p 0.01, OR= 5.6, 95 % CI=1.3-24.3) were found as significant predictors.The relapsing nature of the disease presents a major challenge, and 60 % of the patients have a high relapse rate [3], with a subsequent risk of steroid toxicity and complications and with half of those relapsing eventually becoming steroid dependent [4].By early identification of those children who are likely to develop steroid dependency and its attendant morbidity, the attending clinician will be able to plan the long term management of these children and minimizing the steroid side effects. …”

mentioning

confidence: 99%

“…The relapsing nature of the disease presents a major challenge, and 60 % of the patients have a high relapse rate [3], with a subsequent risk of steroid toxicity and complications and with half of those relapsing eventually becoming steroid dependent [4].…”

mentioning

confidence: 99%

Risk Factors for Steroid Dependency in Children with Idiopathic Nephrotic Syndrome in India

2015

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To the Editor: Minimal change nephrotic syndrome (MCNS) is the most common cause of idiopathic nephrotic syndrome (INS) with a 2:1 predilection for boys. INS has a more favourable prognosis and is characterised by steroid responsiveness in approximately 90 % of patients [1,2]. The incidence of relapse rate is high and approximately half of them develop steroid dependency. Many predictors of steroid dependency have been proposed i.e., duration from initial steroid therapy to response, concomitant upper respiratory tract infection during relapse, relapse during the first half year after disease onset, low serum protein level, gender, age at onset, total cholesterol and steroid regimen used.We conducted our study to determine the predictive risk factors for development of steroid dependency in children with INS. The records of 125 children with steroid responsive INS were retrospectively studied; out of which 38 children (23.4 %) were steroid dependent. It was found that time duration of remission (<10 d) from start of therapy (p 0.00, OR= 1.1, 95 % CI=1.0-1.1) and steroid regime other than 6 wk daily (2 mg/kg)+6 wk alternate day (1.5 mg/kg) (p 0.01, OR= 5.6, 95 % CI=1.3-24.3) were found as significant predictors.The relapsing nature of the disease presents a major challenge, and 60 % of the patients have a high relapse rate [3], with a subsequent risk of steroid toxicity and complications and with half of those relapsing eventually becoming steroid dependent [4].By early identification of those children who are likely to develop steroid dependency and its attendant morbidity, the attending clinician will be able to plan the long term management of these children and minimizing the steroid side effects.

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Predicting First-Year Relapses in Children With Nephrotic Syndrome

Abstract: We conclude that of all the presenting features, the rapidity of initial response to steroid therapy combined with the presence of hematuria, could predict future relapses and should be well documented.

Cited by 70 publications

References 13 publications

Steroid Responsiveness of Children with Idiopathic Nephrotic Syndrome in Southeastern Region of Turkey

Steroid Responsiveness of Children with Idiopathic Nephrotic Syndrome in Southeastern Region of Turkey

Analysis of Predictors of Relapse in Children with Steroid Sensitive Nephrotic Syndrome

Risk Factors for Steroid Dependency in Children with Idiopathic Nephrotic Syndrome in India

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