Abstract
ObjectiveSteroid-sensitive nephrotic syndrome (SSNS) in children is often complicated by one or more relapses, as manifested by the appearance of proteinuria. Besides health-related triggers, psychological stress might be related to relapse. This longitudinal study examined the link between perceived stress, emotional valence (feeling happy vs. unhappy) and daily reported proteinuria, and investigated the temporal relation between stressful events and proteinuria. MethodSixteen children (4–13 years) diagnosed with SSNS were included. Patients kept an online diary for an average of 124 days, wherein they reported proteinuria (n = 1985 urine samples), perceived stress, emotional valence, medication use and health complaints. Stressful days were determined at the start of the study. Using multilevel analysis, the following associations were tested: (1) the relation between perceived stress, emotional valence and proteinuria, and (2) the temporal relation between stressful days and proteinuria. ResultsAppearance of proteinuria was reported in 410/1985 urine samples. Perceived stress and not emotional valence significantly predicted proteinuria (95% CI [0.11, 0.27]), even five days later. There was a significant temporal association between stressful days and proteinuria (95% CI [0.22, 1.14]). The effect sizes of these associations were small, f = 0.04 and f = 0.12, respectively. ConclusionsOur findings suggest that psychological stress may trigger proteinuria in children with SSNS. Future research in larger samples is needed to support our findings.
Highlights
Steroid-sensitive idiopathic nephrotic syndrome (SSNS) is a severe kidney disease with proteinuria, hypoproteinemia, hyperlipidemia and the appearance of edema
We prospectively examined the relation between perceived stress, emotional valence and daily reported proteinuria in a sample of children with sensitive nephrotic syndrome (SSNS)
Because this study aimed to investigate the temporal relation between stressful events and proteinuria, seven days before and after a stressful event were marked as stressful days (1), and the seven days after this period were marked as control days (0)
Summary
Steroid-sensitive idiopathic nephrotic syndrome (SSNS) is a severe kidney disease with proteinuria, hypoproteinemia, hyperlipidemia and the appearance of edema. Negative events that may elicit stress in children are, for example, failing a grade in school or the death of a grandparent (Coddington, 1972) Positive events, such as a holiday or a birthday, have been associated with stress (Van Kampen, Jansen, Steinbusch, Joëls, & Baals, 2012), possibly because they impact the daily routine or familiar environment of regular life before and after the stressful event. Positive emotions in reaction to stress can relieve the level of stress and may be a buffer against dysregulation (Bai & Repetti, 2018) To summarize, both stressful life events and subjective stress (i.e., perceived stress and emotional valence) may contribute to dysregulated psychological and biological functioning
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
