Predictors of poor outcome in children with steroid sensitive nephrotic syndrome

Abstract

Background and objectiveNearly 50% of the children with steroid sensitive nephrotic syndrome (SSNS) have a frequently relapsing (FR) or steroid dependent (SD) course, experiencing steroid toxicities and complications of immunosuppression. The study aimed to compare parameters between children with infrequent relapsing (IFR) and FR/SD nephrotic syndrome and to identify the factors associated with a FR/SD course. MethodsA retrospective analysis of medical records from 2009 to 2014, of children with SSNS attending the pediatric nephrology clinic in a tertiary care medical college and hospital. ResultsOut of 325 children (226 males) with SSNS, 213 were IFR and 112 were FRNS/SDNS. The median age of onset was 34 (IQR 24–48) months. The median time to the first relapse was 4 (IQR 3–7) months and 6 (IQR 4–12) months in FR/SD and IFR group respectively. Multivariate logistic regression analysis showed “adequate treatment (≥12 weeks) of the first episode” (odds ratio 0.56, 95% CI 0.34–0.91; p value=0.02) and “shorter median time to the first relapse” (odds ratio 1.04, 95% CI=1.01–1.08; p value=0.04) to be independent predictors of FR/SD course.An ROC curve was constructed which showed that time to first relapse <5.5 months was associated with a sensitivity of 69% and specificity of 60% in predicting a FR/SD course. ConclusionAdequate treatment of the first episode is associated with less chance of an FR/SD course. After treatment of first episode, the first relapse occurring within 5.5 months may predict a frequently relapsing or steroid dependent course.