Clinico-Biochemical Profile and Identification of Independent Risk Factors of Frequent Relapse in Childhood-Onset Steroid-Sensitive Nephrotic Syndrome.

Abstract

Background and aimNephrotic syndrome is one of the commonest glomerular diseases in children, and the majority of them have minimal change lesions in histology with a favorable outcome. Most children with minimal change disease (MCD) are steroid-sensitive, but half of them have a frequent relapse and a prolonged course. This study was conducted to evaluate the clinical manifestations and biochemical profile and to determine independent risk factors of frequent relapse in children with steroid-sensitive nephrotic syndrome (SSNS).MethodsThis was a tertiary care hospital-based observational study conducted at the pediatric department of Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India, from October 2017 to September 2019. Fifty-three children from age one to 15 years admitted with steroid-sensitive nephrotic syndrome diagnosed as per the International Study of Kidney Disease in Children (ISKDC) criteria were enrolled in the study. On admission, history-taking, physical examination, and routine hematological and biochemical tests were carried out. Children who had no infection were started oral prednisolone at the dose of 2 mg/kg/day for six weeks, followed by 1.5 mg/kg/day on alternate days for six weeks with daily follow-up for evidence of proteinuria till remission. The parameters evaluated were age at presentation, sex, type of presentation, precipitating factors, laboratory findings, and rapidity of steroid response. All children were followed up for one year, and those with no relapse over a period of one year after remission served as the control group to determine the risk factors for relapse. Data were analyzed using standard statistical software (Stata version 13.1, StataCorp LLC, College Station, Texas, USA).ResultsOf the 53 cases, 47% of the children had a relapse. In the relapse category, 88% were male, and 67% were between one and 5.5 years. The clinical manifestations during the first episode in the relapse group were similar to the no relapse group. Investigations revealed that 64% of the children with relapse had serum total protein ≤ 4.2 g/dL (p = 0) and that 59% had serum albumin ≤ 1.8 g/dL (p = 0.004). In the relapse group, 41% of the children went into remission within two weeks of initiation of therapy as compared with 80% in the no relapse group.ConclusionThe risk factors determined for relapse in SSNS are male sex, younger age, low serum albumin, low serum total protein, and delayed response to steroid therapy.