Abstract
Introduction: Idiopathic nephrotic syndrome is the commonest glomerular disease in children. Relapses are common and 50% with multiple relapses become steroid dependent requiring prolonged immunosuppressive treatment.
Methods: A hospital based prospective follow up study with nested case control design was conducted in children with first episode of Idiopathic Nephrotic syndrome to determine predictive risk factors for steroid dependency. Age at onset, birth weight, concurrent respiratory tract infections, hematuria at onset, hypertension and time to remission were assessed as predictive risk factors for dependency.
Results: 146 children were recruited. After excluding 6 steroid resistant ones, 137 were followed up for one year.14.5%[20] children became steroid dependent, 54.7% [75] had infrequent relapses and 30.65% [42] had no relapses. Small for gestational age (SGA),[P 0.000, OR 7.59, 95% CI 2.72 – 21.17], more than 10 days to attain remission [P 0.000, OR 7.19 , 95% CI 2.58 – 20.0] and concurrent upper respiratory tract infection during relapses xz[P 0.000, OR 6.88, 95% CI 2.16 – 21.92] were significant factors associated with steroid dependence. The area under an ROC curve plotted to evaluate the prediction model based on the time to attain remission (more than 10 days) showed 0.792 (95% CI 0.678 – 0.906).
Conclusion: Time to remission of more than 10 days, concomitant respiratory tract infections with relapse and being SGA were significant predictors for development of steroid dependence. Identification of children at risk for dependency at onset will help in counseling and planning treatment strategies avoiding drug toxicity and reducing morbidity.
Keywords: Nephrotic Syndrome; Remission, Relapses, Dependence.
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Corresponding Author
Bindu Sarojam MD Pediatrics
Department of Pediatrics, SAT Hospital, Govt. Medical College, Thiruvananthapuram, Kerala, India
DOI: https://dx.doi.org/10.18535/jmscr/v10i1.11
