Risk factors for steroid dependency in children with idiopathic nephrotic syndrome

Yap, Hui-Kim; Han, Eugene; Heng, Chew-Kiat; Gong, Wei-Kin

doi:10.1007/s004670100024

Cited by 69 publications

(49 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…But the treatment efficiency analysis indicated that the PRED protocol (PRED along) led to disease recurrence primarily during the first 6 months after treatment withdrawal (Model 2), which is in agreement with the other studies, see e.g. [9,27]. Moreover, in the multivariate consideration, models fitted for the NS course prediction demonstrated that PRED treatment remained highly significant factor for all types of relapses analyzed (Models 1 to 4).…”

Section: Discussionsupporting

confidence: 89%

Clinical Course of Steroid Sensitive Nephrotic Syndrome in Children: Outcome and Outlook

Fomina¹

2011

TOPEDJ

View full text Add to dashboard Cite

Abstract:Introduction: The aim of our study was to investigate the relative efficiency and adverse effects of various treatments of steroid sensitive nephrotic syndrome (SSNS) in children, and to determine factors associated with relapse risk in these patients. Materials and Method:We retrospectively studied the data from 690 SSNS children treated in referral center over 25 years. The analyzed treatment protocols were: Prednisolone (PRED, eight weeks in a dose 1.5-2.0 mg/kg, then it tapering and given for 9-12 months), Chlorambucil (CHL, cumulative dose 28.5-30 mg/kg), Cyclophosphamide intravenously (CYC I.V., cumulative dose of 30-36 mg/kg, then supporting dose of CHL, cumulative dose of 20-25 mg/kg) and intramuscular (CYC I.M., cumulative dose of 120-150 mg/kg). The alkylating agents were used after remission induction by PRED and under its protection.Results: Cumulative relapse-free survival was 81.9%, 69.0% and 64.5% after 12, 36 and 60 months, respectively. In multivariate analyses, relapse risk was associated with age of treatment (<6 years), and both PRED and CYC I.V. The only predictive factor for early relapse was PRED, unlike two and more relapses group where PRED and CYC I.V. as well as age from 3 to 6 years was highly prognostic. The high probability of sustained remission in combination with relatively mild adverse effects was observed for PRED used at first episode and CHL used at relapse. Conclusion:To summarize, our protocols characterized by the prolonged PRED and CHL demonstrated promising results and should be considered as an efficient alternative strategy in SSNS management.

show abstract

Section: Discussionsupporting

confidence: 89%

Clinical Course of Steroid Sensitive Nephrotic Syndrome in Children: Outcome and Outlook

Fomina¹

2011

TOPEDJ

View full text Add to dashboard Cite

show abstract

“…3,20,22,23 However, others did not find an effect of age on the clinical course of NS. 21,24,25 Side effects were equally distributed over the two treatment groups. Cushingoid side effects, high BP, and behavioral changes were clearly present but transient in the vast majority of patients.…”

Section: Discussionmentioning

confidence: 99%

Extending Prednisolone Treatment Does Not Reduce Relapses in Childhood Nephrotic Syndrome

Teeninga

Holthe

Rijswijk

et al. 2013

Journal of the American Society of Nephrology

120

View full text Add to dashboard Cite

Prolonged prednisolone treatment for the initial episode of childhood nephrotic syndrome may reduce relapse rate, but whether this results from the increased duration of treatment or a higher cumulative dose remains unclear. We conducted a randomized, double-blind, placebo-controlled trial in 69 hospitals in The Netherlands. We randomly assigned 150 children (9 months to 17 years) presenting with nephrotic syndrome to either 3 months of prednisolone followed by 3 months of placebo (n=74) or 6 months of prednisolone (n=76), and median follow-up was 47 months. Both groups received equal cumulative doses of prednisolone (approximately 3360 mg/m 2 ). Among the 126 children who started trial medication, relapses occurred in 48 (77%) of 62 patients who received 3 months of prednisolone and 51 (80%) of 64 patients who received 6 months of prednisolone. Frequent relapses, according to international criteria, occurred with similar frequency between groups as well (45% versus 50%). In addition, there were no statistically significant differences between groups with respect to the eventual initiation of prednisolone maintenance and/or other immunosuppressive therapy (50% versus 59%), steroid dependence, or adverse effects. In conclusion, in this trial, extending initial prednisolone treatment from 3 to 6 months without increasing cumulative dose did not benefit clinical outcome in children with nephrotic syndrome. Previous findings indicating that prolonged treatment regimens reduce relapses most likely resulted from increased cumulative dose rather than the treatment duration.

show abstract

“…According to Yap et al, in a group of children with INS responding to steroid therapy, frequent relapse and steroid dependence was found significantly higher in children who had upper respiratory tract infection and responded to initial steroid therapy after nine days. [15] Studies have demonstrated that relapse is frequently seen after upper respiratory tract infection occurring in the spring. [16] Relapse developed at least once in 32.1% of patients having a dependence to or responding to steroid therapy.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2007

View full text Add to dashboard Cite

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.

show abstract

Risk factors for steroid dependency in children with idiopathic nephrotic syndrome

Cited by 69 publications

References 9 publications

Clinical Course of Steroid Sensitive Nephrotic Syndrome in Children: Outcome and Outlook

Clinical Course of Steroid Sensitive Nephrotic Syndrome in Children: Outcome and Outlook

Extending Prednisolone Treatment Does Not Reduce Relapses in Childhood Nephrotic Syndrome

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

Contact Info

Product

Resources

About