Cognitive and Behavioral Aspects in Children with Nephrotic Syndrome; Does it Need Special Attention

Abstract

Purpose: This study was done to see and assess the cognitive and behavioral impairment in children with nephrotic syndrome and to find out any relationship with disease-specific or treatment specific characteristics. Methods: This one-year case-control study was conducted from October 2018 to November 2019 among the diagnosed case of nephrotic syndrome, age range 3-16 year without an active stage of nephrosis or infection. Control groups were selected from age and sex-matched patients admitted in the same hospital after controlled active disease and without any chronic illness. The Wechsler Intelligence Scale for children (WISC) for assessment of Cognitive function was performed in both groups. Moreover, to assess behavioral impairment, the Strengths and Difficulties Questionnaire (SDQ) were performed in both groups. Results: Among the case group steroid dependency was noted with 58.1% and about 27% received for prolong period (> 3months). A total cumulative dose before hospital admission was 384.16±206.94 mg/kg. All the domains of cognitive parameter and behavioral parameters affected significantly in nephrotic syndrome children than the control group(p<0.05). Mostly affected cognition domains were verbal 72% and processing speed 74%. Considering behavioral parameters, conduct 44.2% and hyperactive 14.2% disorders were affected severely among these children. Both the cognitive and behavioral impairment were significantly affected by prolonged corticosteroid therapy(p<0.0001). Conclusion: Severe psychosocial and emotional impairment are commonly seen among those children who are getting steroid for a prolonged period, which argues in favor of a low threshold for switching to sparing drugs.