Prediction of Short- and Long-Term Outcomes in Childhood Nephrotic Syndrome

Carter, Simon A.; Mistry, Shilan; Fitzpatrick, Jessica; Banh, Tonny; Hébert, Diane; Langlois, Valérie S.; Pearl, Rachel; Chanchlani, Rahul; Licht, Christoph; Radhakrishnan, Seetha; Brooke, Josefina; Reddon, Michele; Levin, Leo; Aitken-Menezes, Kimberly; Noone, Damien; Parekh, Rulan S.

doi:10.1016/j.ekir.2019.12.015

Cited by 36 publications

(46 citation statements)

References 31 publications

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“…Our study revealed that the predictors for FR/SD NS with steroid therapy were younger age (≤6 years) at initial diagnosis (p=0.00), presence of hematuria (p=0.00), infection (p=0.01), acute renal failure (p=0.01), serum albumin below 1.5g/dl (p=0.01) at diagnosis and lack of remission within 2 weeks (p=0.0) of therapy. Similarly, other studies found a younger age at diagnosis, 23 , 25 presence of hematuria, 16 , 17 , 31 time to remission with initial therapy, and duration of steroid therapy, 16 , 17 presence of infection, 31 hypoalbuminemia 19 were independent predictors of relapse. The possible reasons for the variations may be differences in sociodemographics and clinical characteristics included participants and study methods employed.…”

Section: Discussionsupporting

confidence: 52%

“…The presence of hematuria, time taken to respond during initial therapy, and duration of steroid therapy were associated with higher FR/SD NS. 16 , 17 Also, time to first relapse and inadequate initial therapy were reported as predictors of developing FR/SD NS disease course. 9 Patients with frequently relapsing nephrotic syndrome have treatment options that include extended dosing of glucocorticoids, cytotoxic agents, mycophenolate mofetil, or calcineurin inhibitors.…”

Section: Introductionmentioning

confidence: 99%

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Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Welegerima¹,

Feyissa²,

Nedi³

2021

IJNRD

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Background: Nephrotic syndrome is a common glomerular disease in children with a relapsing course that leads to complications and steroid-related toxicities. In Ethiopia, data on the outcomes of steroid therapy in pediatric nephrotic syndrome patients are limited. Objective: The aim of the study was to assess the treatment outcomes of pediatric nephrotic syndrome patients in Ayder Specialized Comprehensive and Mekelle General Hospitals. Methods: A retrospective study was conducted among children treated for nephrotic syndrome from 2010 to 2017 in Ayder Comprehensive Specialized and Mekelle General Hospitals. Univariate and multivariate logic regression analyses were performed to identify determinants of treatment outcome with a p-value <0.05 considered statistically significant. Results: A total of 159 pediatric patients treated for nephrotic syndrome in both hospitals were included in this study. The mean age of participants at the initial diagnosis was 5.21 ± 2.66 years. Most of the patients 150 (94.3%) achieved remission within 4 weeks of steroid therapy. Among initial responders, the majority of the patients 117 (78%) encountered relapses of which 65 (40.9%) were developed frequent relapse/steroid-dependent nephrotic syndrome. Also, the majority of patients 102 (64.5%) encountered steroid-related toxicities. The predictors of frequent relapse/steroid-dependent nephrotic syndrome were age of ≤6 years (AOR=3.16; p=0.00), hematuria (AOR=6.74; p=0.00), infection (AOR=3.28; p=0.01), acute renal failure (AOR=6.09; p=0.01), serum albumin below 1.5g/dl (8.38, p=0.01) and lack of remission within 2 weeks (AOR=3.69; p=0.00). Conclusion:Most of the pediatric NS patients treated in ACSH and MGH have achieved remission with initial to steroid therapy. However, there was a higher relapse rate and steroidrelated toxicities among pediatric NS patients who achieved remission. Early age at diagnosis, hematuria, reduced GFR, infection, and remission time were the independent predictors of the frequent relapsing/steroid-dependent nephrotic disease course.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Welegerima¹,

Feyissa²,

Nedi³

2021

IJNRD

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“…Furthermore, ethnic differences in disease response to treatment are not supported by recent cohort studies. 20,21…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Daily Low-Dose Prednisolone During Upper Respiratory Tract Infection to Prevent Relapse in Children With Relapsing Steroid-Sensitive Nephrotic Syndrome

Christian¹,

Webb

Mehta

et al. 2022

JAMA Pediatr

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IMPORTANCEIn children with corticosteroid-sensitive nephrotic syndrome, many relapses are triggered by upper respiratory tract infections. Four small studies found that administration of daily low-dose prednisolone for 5 to 7 days at the time of an upper respiratory tract infection reduced the risk of relapse, but the generalizability of their findings is limited by location of the studies and selection of study population.OBJECTIVE To investigate the use of daily low-dose prednisolone for the treatment of upper respiratory tract infection-related relapses.DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled randomized clinical trial (Prednisolone in Nephrotic Syndrome [PREDNOS] 2) evaluated 365 children with relapsing steroid-sensitive nephrotic syndrome with and without background immunosuppressive treatment at 122 pediatric departments in the UK from February 1, 2013, to January 31, 2020. Data from the modified intention-to-treat population were analyzed from July 1, 2020, to December 31, 2020.INTERVENTIONS At the start of an upper respiratory tract infection, children received 6 days of prednisolone, 15 mg/m 2 daily, or matching placebo preparation. Those already taking alternate-day prednisolone rounded their daily dose using trial medication to the equivalent of 15 mg/m 2 daily or their alternate-day dose, whichever was greater. MAIN OUTCOMES AND MEASURESThe primary outcome was the incidence of first upper respiratory tract infection-related relapse. Secondary outcomes included overall rate of relapse, changes in background immunosuppressive treatment, cumulative dose of prednisolone, rates of serious adverse events, incidence of corticosteroid adverse effects, and quality of life. RESULTSThe modified intention-to-treat analysis population comprised 271 children (mean [SD] age, 7.6 [3.5] years; 174 [64.2%] male), with 134 in the prednisolone arm and 137 in the placebo arm. The number of patients experiencing an upper respiratory tract infection-related relapse was 56 of 131 (42.7%) in the prednisolone arm and 58 of 131 (44.3%) in the placebo arm (adjusted risk difference, −0.02; 95% CI, −0.14 to 0.10; P = .70). No evidence was found that the treatment effect differed according to background immunosuppressive treatment. No significant differences were found in secondary outcomes between the treatment arms. A post hoc subgroup analysis assessing the primary outcome in 54 children of South Asian ethnicity (risk ratio, 0.66; 95% CI, 0.40-1.10) vs 208 children of other ethnicity (risk ratio, 1.11; 95% CI, 0.81-1.54) found no difference in efficacy of intervention in those of South Asian ethnicity (test for interaction P = .09). CONCLUSIONS AND RELEVANCEThe results of PREDNOS 2 suggest that administering 6 days of daily low-dose prednisolone at the time of an upper respiratory tract infection does not reduce the risk of relapse of nephrotic syndrome in children in the UK. Further work is needed to investigate interethnic differences in treatment response.

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“…Hastaların prognozları açısından değerlendirdiğimizde halen takip edilen 103 hastanın %17.4'ünde evre 5 KBH nedeniyle renal replasman tedavisi başlandı. Literatürde 631 NS tanılı çocuk hastanın alındığı bir çalışmada hastaların %1.7'sinde ortanca 3.9 yıl takip süresi sonunda evre 5 KBH geliştiği bildirilmiştir (15). Sadece steroide dirençli NS tanılı çocuk hastaların alındığı bir çalışmada ise hastaların %26.8'inde evre 5 KBH geliştiği bildirilmiştir (16).…”

Section: Discussionunclassified

Nefrotik Sendrom Tanılı Çocukların Son Beş Yılda Hastaneye Yatış Endikasyonları ve Prognozları

Atmış¹,

Cevizli²,

Bayazıt³

2021

Turkish Journal of Pediatric Disease

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Bu çalışma ile kliniğimizde nefrotik sendrom tanısıyla takip edilen çocuklarda hastaneye yatış nedenlerinin belirlenmesi, klinik özelliklerinin incelenmesi ve prognozlarının değerlendirilmesi amaçlandı.Gereç ve Yöntemler: Çalışmamızda Çukurova Üniversitesi Çocuk Nefroloji Bilim Dalında nefrotik sendrom tanısıyla takip edilen hastaların son beş yıldaki hastaneye yatış nedenleri incelendi. Halen takibimizde olan hastalar ise prognozları açısından değerlendirildi.Bulgular: Çukurova Üniversitesi Tıp Fakültesi Çocuk Nefroloji servisine nefrotik sendrom tanısıyla 2015-2019 yılları arasında toplam 117 çocuk 299 kez yatırıldı. Bu hastaların 58'i (%49.6) kızdı. Hastaların ortalama yatış günü 9.98±16.91 gündü. Hastaların en sık yatış nedenleri ritüksimab infüzyonu (%24.7), böbrek biyopsisi (%22.1), pulse metilprednisolon (%12.7), ağır ödem (%12.4) ve enfeksiyonlardı (%11). Takibe devam eden hastalar prognozları açısından incelendiğinde hastaların %51.5'ü remisyonda iken %17.4'üne evre 5 kronik böbrek hastalığı nedeniyle renal replasman tedavisi (RRT) başlandı. Son takiplerinde RRT yapılan hastaların ortalama hastanede yatış günü 24.4±33.1 gün iken, RRT ihtiyacı olmayan hastalarda 7.9±10.7 gündü (p <0.001). Hastaların hastanede toplam yatış süreleri ile mortalite arasında anlamlı bir ilişki saptanmadı (p = 0.62). NS tanılı hastalarda RRT yapılması ile mortalite arasında anlamlı bir ilişki saptandı (p <0.001). Sonuç:Hastanemiz bölgemizde bir referans hastanesi olduğundan kliniğimizde çok sayıda NS tanılı çocuk hasta takip edilmektedir. Hastanede toplam yatış gün sayısı ile morbiditeye ve mortaliteye neden olan RRT ihtiyacı arasında anlamlı bir ilişkili bulunmuştur. Nefrotik sendromlu çocuk hastaların prognozu çoğunlukla iyi olsa da hayati tehdit edici komplikasyonlar ve mortalite görülebilmektedir.

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Prediction of Short- and Long-Term Outcomes in Childhood Nephrotic Syndrome

Cited by 36 publications

References 31 publications

Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Evaluation of Daily Low-Dose Prednisolone During Upper Respiratory Tract Infection to Prevent Relapse in Children With Relapsing Steroid-Sensitive Nephrotic Syndrome

Nefrotik Sendrom Tanılı Çocukların Son Beş Yılda Hastaneye Yatış Endikasyonları ve Prognozları

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