Childhood Nephrotic Syndrome Management and Outcome: A Single Center Retrospective Analysis

Abstract

There is a paucity of information on outpatient management and risk factors for hospitalization and complications in childhood nephrotic syndrome (NS). We described the management, patient adherence, and inpatient and outpatient usage of 87 pediatric NS patients diagnosed between 2006 and 2012 in the Atlanta Metropolitan Statistical Area. Multivariable analyses were performed to examine the associations between patient characteristics and disease outcome. We found that 51% of the patients were treated with two or more immunosuppressants. Approximately half of the patients were noted to be nonadherent to medications and urine protein monitoring. The majority (71%) of patients were hospitalized at least once, with a median rate of 0.5 hospitalizations per patient year. Mean hospital length of stay was 4.0 (3.8) days. Fourteen percent of patients experienced at least one serious disease complication. Black race, frequently relapsing/steroid-dependent and steroid-resistant disease, and the first year following diagnosis were associated with higher hospitalization rates. The presence of comorbidities was associated with longer hospital length of stay and increased risk of serious disease complications. Our results highlight the high morbidity and burden of NS and point to particular patient subgroups that may be at increased risk for poor outcome.

Childhood nephrotic syndrome in Southeast Nigeria: The old story or any change in pattern?

“…The male preponderance of NS in our center was in agreement with the previous studies in and outside Nigeria [1,4,[10][11][12]18]. The peak age of 7-9 years observed in this study was in accordance with the findings by Okoro et al [10], Obiagwu et al [11], Adedoyin et al [18], and Adeleke et al [19].…”

A dual efficacy-implementation trial of a novel mobile application for childhood nephrotic syndrome management: the UrApp for childhood nephrotic syndrome management pilot study protocol (UrApp pilot study)

“…Sample size and power estimates are based on 55% adherence in the control group and 90% in the UrApp intervention group. These estimates are based on our single center experience with SOC [6] and our experience with text messaging for NS monitoring, where 94% of the participants continued to check urine and provide results via text messaging at the end of 1 year [12]. Power was calculated using a twosided Z-test with pooled variance at 0.05 type I error rate using PASS v. 14.0.8 (Kaysville.…”

“…5 University of Minnesota Masonic Children's Hospital, Minneapolis, GA, USA. 6 Oregon Health and Science University, Portland, OR, USA.…”

“…Though > 80% of children will achieve remission with corticosteroid treatment, the majority will experience subsequent relapses, with more than half relapsing frequently or becoming dependent on corticosteroids to maintain remission [2][3][4][5]. During a relapse, patients can develop complications such as anasarca, acute kidney injury, serious infections, or thromboembolic events, necessitating hospitalization [6]. In the U.S. in 2006 and 2009, childhood NS resulted in an estimated 48,700 inpatient days and charges totalling $259 million [7].…”

“…Not unlike other chronic, relapsing-remitting pediatric disorders, self-management is difficult for NS patients and their caregivers. Adherence to urine protein testing and medications are low [6,9]. In a focus group and individual interview study, parents reported difficulty understanding the clinical meaning of urine protein results and knowing when to report and act on urine protein changes [10].…”