Clinical course and outcome of steroid sensitive nephrotic syndrome in children: a single center experience

Abstract

It is difficult at present to predict the long-term course of steroid sensitive nephrotic syndrome (SSNS) regarding the probability of relapse. We retrospectively reviewed 42 SSNS patients who had been followed up for a mean duration of 10 ±3 years. Male was predominantly affected (M:F = 3.5:1). Sixty percent of our children presented between 2 to 5 years old. At the time of last follow- up, seven patients (17%) never had a relapse. Twenty-three patients (55%) went into long-term remission and 12 (28%) continued to have active disease. Kidney biopsies were performed in 18 patients (43%). The most common histology was minimal change disease (71%), followed by IgM nephropathy (28%). Thirty-four patients (81%) followed the steroid treatment protocol of the International Study of Kidney Disease in Childhood (ISKDC). Sixteen patients (38%) required second line medications. The most common steroid sparing agents used were levamisole, followed by cyclophosphamide and cyclosporin A. The nonrelapsers had a higher serum albumin than the relapsers, with a p value of 0.03. From the second year of follow-up onwards, the long-term remission group had fewer episodes of relapses than the active disease group, with a p value of ≤ 0.034 at the second subsequent years. The median time to achieve the long-term remission is 3 years (95% confidence interval: 1.85-4.15) in our patients. Among all the prognostic factors studied, a higher serum albumin at presentation and a fewer number of relapses per year appeared to be related to a less relapsing course.