Clinical Course of Steroid Sensitive Nephrotic Syndrome in Children: Outcome and Outlook

Kassa

International Journal of Pediatrics

et al. 2020

Background. Relapse in children with nephrotic syndrome leads to a variety of complications due to prolonged treatment and potential dependency on steroids. However, there is no study conducted to determine the incidence and predictive factors of relapse for nephrotic syndrome in Ethiopia, especially in children. Thus, this study aimed to assess the incidence of relapse and its predictors among children with nephrotic syndrome in Ethiopia. Methods. A retrospective study was conducted by reviewing all charts of children with an initial diagnosis of the nephrotic syndrome in tertiary hospitals from 2011 to 2018. Charts of children with a diagnosis of steroid-resistant cases were excluded. The extraction tool was used for data collection, Epi-data manager V-4.4.2 for data entry, and Stata V-14 for cleaning and analysis. Kaplan-Meier curve, log-rank test, life table, and crude hazard ratios were used to describe the data and adjusted hazard ratios with 95% CI and P value for analysis. Median relapse time, incidence rate of relapse, and cumulative relapse probabilities at a certain time interval were computed. Bivariable and multivariate analyses were performed using the Cox proportional hazard regression to identify the factors associated with relapse. Any variable at P < 0.25 in the bivariable analysis was transferred to multivariate analysis. Then, the adjusted hazard ratio with 95% CI and P ≤ 0.05 was used to report the association and to test the statistical significance, respectively. Finally, texts, tables, and graphs were used to present the results. Results and Conclusion. Majority, 64.5% (40/66), of relapses were recorded in the first 12 months of follow-up. The incidence rate of relapse was 42.6 per 1000 child-month-observations with an overall 1454 child-month-observations and the median relapse time of 16 months. Having undernutrition [ AHR = 3.44 ; 95% CI 1.78-6.65], elevated triglyceride [ AHR = 3.37 ; 95% CI 1.04-10.90], decreased serum albumin level [ AHR = 3.51 ; 95% CI 1.81-6.80], and rural residence [ AHR = 4.00 ; 95% CI 1.49-10.76] increased the hazard of relapse. Conclusion and Recommendation. Relapse was higher in the first year of the follow-up period. Undernutrition, hypoalbuminemia, hypertriglyceridemia, and being from rural areas were independent predictors of relapse. A focused evaluation of those predictors during the initial diagnosis of the disease is compulsory.

Section: Discussionmentioning

confidence: 99%

“…It is characterized by heavy proteinuria (40 mg/m2/hr in children), hypoalbuminemia (<2.5 g/dl), peripheral edema, and hyperlipidemia [ 5 , 6 ]. Nephrotic syndrome (NS) affects children of any age and is most commonly seen among school-age children and adolescents [ 7 ]; although, the risk of relapse decreases in adolescents [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Time to Relapse and Its Predictors among Children with Nephrotic Syndrome in Comprehensive Specialized Hospitals, Tigray, Ethiopia, 2019

Kassa

International Journal of Pediatrics

et al. 2020

“…Childhood NS is often steroid sensitive, usually with favorable long-term prognosis characterized by a relapsing course in 50-80% of cases [8]. However, a major problem in the management of children who have frequent relapses is the serious side effects resulting from continuous steroid therapy [9].…”

Section: Discussionmentioning

confidence: 99%

Treatment Strategies for Childhood Steroid-Resistant Nephrotic Syndrome

Talaat

2013

BJMMR

“…Relapse in children with nephrotic syndrome is the reappearance of proteinuria for at least three consecutive days following achievement of remission (1, 2). Although nephrotic syndrome can affect children of any age, from infancy through adolescence (3), the risk of relapse is highest in school-aged groups; nevertheless, the risk of relapse reduces in adolescents (4).…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of relapse among children with nephrotic syndrome at Assosa zone hospitals, Benishangul Gumuz Region, Northwest Ethiopia, 2022

Gashaw

Tekeba

Terefe

et al. 2022

Preprint

BackgroundRelapse is the major problem in children with nephrotic syndrome and leads to a substantial burden on the patient and family worldwide, particularly in resource-limited countries like Ethiopia. However, little is known about the incidence of relapse and its predictors among children with nephrotic syndrome in the study area.MethodsAn institution-based retrospective follow-up study was conducted among 354 randomly selected nephrotic syndrome patients admitted from April 2017 to March 2022. Data entry was carried out using Epi-data manager version 4.6.0.6 and Stata software version 14 for data cleaning and analysis. Cox-proportional hazard models were used to identify predictors of relapse. Any variable with a p-value < 0.25 in the bivariable was taken into the multivariable analysis, and then the association and statistical significance were declared at P≤ 0.05.ResultsMore than half, 55.8% (82/147), of relapses were recorded in the first six months of follow-up. The incidence of relapse was 82.3 per 1000 child-month-observations, with an overall risk of 1785.9 child-month-observations. In children with nephrotic syndrome, the presence of wasting malnutrition [AHR = 1.93, 95% CI 1.28–2.90], acute respiratory tract infections [AHR = 1.79, 95% CI 1.19–2.71], elevated triglyceride levels [AHR = 2.74, 95% CI 1.48–5.07], and low serum albumin levels [AHR = 4.34, 95% CI 22.18–8.64] were predictors of relapse.Conclusion and RecommendationsThe incidence of relapse among nephrotic syndrome patients was high. The independent predictors of relapse in children with nephrotic syndrome were the presence of acute respiratory tract infections, wasting malnutrition at admission, low serum albumin levels, and elevated serum triglyceride levels. Therefore, intervention to reduce and control earlier relapse should focus on preventing relapse-related complications.