Prediction of subsequent relapse in children with steroid-sensitive nephrotic syndrome

Abstract

Among nephrotic children with frequent relapses at risk for cumulative steroid toxicity, identification of children who may be at high risk for subsequent relapse is very important in making the decision to introduce cytotoxic drugs. We examined the clinical course of 467 relapses in 121 steroid-sensitive nephrotic children to elucidate the risk factors for subsequent relapse, using the Cox proportional-hazards regression model. Gender, age at onset, duration of illness from onset, prednisolone dosage at the most-recent relapse, and regimens of initial steroid therapy at onset were not associated with risk. Relapse within the 1st year was a powerful independent predictor of subsequent relapse irrespective of the duration of illness. The hazard ratio of patients with more than one relapse within the 1st year increased to 1.72-2.12 compared with those without a relapse within the 1st year. The remission period just before the most-recent relapse was also a significant predictor. The risk for patients with a 1-year or longer remission period decreased to 0.57. Patients treated with cyclophosphamide for 12 weeks had a significantly longer remission than those treated with prednisolone alone. Our results suggest that early relapse after onset and/or a short remission period just before recent relapse are independent risk factors for subsequent relapse. Cytotoxic therapy has serious adverse effects and its effect may be limited. Our results may be helpful in deciding on the suitability of cytotoxic drugs.

Extending Prednisolone Treatment Does Not Reduce Relapses in Childhood Nephrotic Syndrome

“…3,20,22,23 However, others did not find an effect of age on the clinical course of NS. 21,24,25 Side effects were equally distributed over the two treatment groups. Cushingoid side effects, high BP, and behavioral changes were clearly present but transient in the vast majority of patients.…”

Long-term effects of levamisole treatment in childhood nephrotic syndrome

“…Histologically, the condition usually corresponds to minimal change nephrotic syndrome (MCNS) [3,4,5]. According to the literature, about 40% of the steroid-sensitive (SSNS) cases are frequently relapsing (FRNS) and they commonly become steroid dependent (SDNS) [6]. Steroid resistance (SRNS) develops in 10% of children and many of these exhibit focal segmental glomerulosclerosis (FSGS) [7].…”

The treatment of relapsing primary nephrotic syndrome in children

“…Currently it is commonly thought that combining with CTX, especially intravenous intermission pulse treatment can certainly reduce the relapse of the illness (Mendoia and Tune, 1995;Takcda et al, 2001). With the same treatment scheme of prednisone, the writers added tripterysium glucosides and compared the results with the CTX-controlled group.…”