Predictors of poor outcome in children with steroid sensitive nephrotic syndrome

Mishra, Kirtisudha; Kanwal, Sandeep Kumar; Sajjan, Sushma Veeranna; Bhaskar, Vikram; Rath, Bimbadhar

doi:10.1016/j.nefro.2017.11.022

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…Patients developing FR/ SD NS require prolonged treatment that leads to toxicity, systemic infections, and other complications. [8][9][10] The common complications experienced with prolonged steroid treatment were cushingoid features, hypertension, hyperlipidemia, hyperglycemia, serious infections, growth retardation, stunted growth, osteopenia, and overall poor quality of life. 9,11 African children have an increased likelihood of developing focal segmental glomerulosclerosis.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] The common complications experienced with prolonged steroid treatment were cushingoid features, hypertension, hyperlipidemia, hyperglycemia, serious infections, growth retardation, stunted growth, osteopenia, and overall poor quality of life. 9,11 African children have an increased likelihood of developing focal segmental glomerulosclerosis. 6,12 This is the most challenging form of NS associated with severe and prolonged proteinuria, high risk of complications, and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…16,17 Also, time to first relapse and inadequate initial therapy were reported as predictors of developing FR/SD NS disease course. 9 Patients with frequently relapsing nephrotic syndrome have treatment options that include extended dosing of glucocorticoids, cytotoxic agents, mycophenolate mofetil, or calcineurin inhibitors. 1 In Ethiopia, there are limited studies on the treatment outcomes of pediatrics NS although it was the second most common cause of pediatric admissions due to renal disease according to a study in Tikur Anbessa Specialized Hospital.…”

Section: Introductionmentioning

confidence: 99%

“…8–10 The common complications experienced with prolonged steroid treatment were cushingoid features, hypertension, hyperlipidemia, hyperglycemia, serious infections, growth retardation, stunted growth, osteopenia, and overall poor quality of life. 9 , 11 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Welegerima¹,

Feyissa²,

Nedi³

2021

IJNRD

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Background: Nephrotic syndrome is a common glomerular disease in children with a relapsing course that leads to complications and steroid-related toxicities. In Ethiopia, data on the outcomes of steroid therapy in pediatric nephrotic syndrome patients are limited. Objective: The aim of the study was to assess the treatment outcomes of pediatric nephrotic syndrome patients in Ayder Specialized Comprehensive and Mekelle General Hospitals. Methods: A retrospective study was conducted among children treated for nephrotic syndrome from 2010 to 2017 in Ayder Comprehensive Specialized and Mekelle General Hospitals. Univariate and multivariate logic regression analyses were performed to identify determinants of treatment outcome with a p-value <0.05 considered statistically significant. Results: A total of 159 pediatric patients treated for nephrotic syndrome in both hospitals were included in this study. The mean age of participants at the initial diagnosis was 5.21 ± 2.66 years. Most of the patients 150 (94.3%) achieved remission within 4 weeks of steroid therapy. Among initial responders, the majority of the patients 117 (78%) encountered relapses of which 65 (40.9%) were developed frequent relapse/steroid-dependent nephrotic syndrome. Also, the majority of patients 102 (64.5%) encountered steroid-related toxicities. The predictors of frequent relapse/steroid-dependent nephrotic syndrome were age of ≤6 years (AOR=3.16; p=0.00), hematuria (AOR=6.74; p=0.00), infection (AOR=3.28; p=0.01), acute renal failure (AOR=6.09; p=0.01), serum albumin below 1.5g/dl (8.38, p=0.01) and lack of remission within 2 weeks (AOR=3.69; p=0.00). Conclusion:Most of the pediatric NS patients treated in ACSH and MGH have achieved remission with initial to steroid therapy. However, there was a higher relapse rate and steroidrelated toxicities among pediatric NS patients who achieved remission. Early age at diagnosis, hematuria, reduced GFR, infection, and remission time were the independent predictors of the frequent relapsing/steroid-dependent nephrotic disease course.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Welegerima¹,

Feyissa²,

Nedi³

2021

IJNRD

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Incidence and Relapse of Idiopathic Nephrotic Syndrome: Meta-analysis

2021

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CONTEXT Idiopathic nephrotic syndrome (INS) in children is a disease with considerable morbidity, yet the incidence and risk for relapse have not been systematically reviewed. OBJECTIVE To estimate the overall pooled weighted incidence and risk for relapse of INS in children. DATA SOURCES Medline and Embase (until December 2020). STUDY SELECTION All studies reporting incidence (per 100 000 children per year) and/or risk for relapse (the proportion of patients who experience ≥1 relapse) of INS in children (age: <18 years) were eligible. DATA EXTRACTION After quality assessment, data were extracted: study (design, localization, and sample size) and patient (age, sex, steroid response, and ethnicity) characteristics, incidence, and risk for relapse. RESULTS After screening, 73 studies were included for analysis (27 incidence, 54 relapse). The overall pooled weighted estimate and corresponding prediction interval (PI) of the incidence was 2.92 (95% PI: 0.00–6.51) per 100 000 children per year. Higher incidences were found in non-Western countries (P < .001). Incidence tended to be lower in white children, but this was not significant. The overall pooled weighted estimate of the risk for relapse was 71.9% (95% PI: 38.8–95.5). Between 1945 and 2011, incidence did not change (P = .39), yet the risk for relapse decreased significantly (P = .024), from 87.4% to 66.2%. LIMITATIONS There was no full-text availability (n = 33), considerable heterogeneity, and limited studies from Africa, Latin America, and Asia. CONCLUSIONS INS has a low incidence with ethnic variation but high risk for relapse. Although corticosteroids have significantly reduced the risk for relapse, it remains unacceptably high, underscoring the need for alternative treatment strategies.

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A child with newly diagnosed kidney disease and his family: determination of early factors of disease progression and features of nephroprotection

Makovetskaya

Poretskova

Mazur

et al. 2023

Ross. vestn. perinatol. pediatr.

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Chronic kidney disease and a decrease in its progression is a global health problem. However, the risk factors associated with the primary nosology of glomerular diseases of children have not been sufficiently studied.Purpose. To determine early risk factors for the progression of chronic kidney disease for more effective prevention of chronization of the process, based on the analysis of clinical and anamnestic data, the features of the manifestation of the primary developed glomerular pathology, and taking into account nosological forms.Material and methods. The experience of own clinical observations, retro- and prospective, related to the formation of chronic kidney disease of children with glomerular pathology is summarized. The study was conducted on the basis of the children’s uronephrological center of the Samara Regional Clinical Hospital named after V.D. Seredavin.Results. The universal risk factors are systematized: transferred critical conditions in the perinatal period with the development of acute kidney injury; prenatally established CAKUT syndrome; the presence of a genetic predisposition to kidney diseases, a complex of allergic diseases in the family; the carriage of persistent infections, hemolytic strains of streptococcus, social determinant, environmental conditions, etc. Specific early risk factors for disease progression, features of the onset of kidney pathology and biomarkers of progression that determine early kidney damage have been identified. The features of nephroprotection are formulated: interdisciplinarity with the inclusion of organizational, social components; operational communication with the outpatient link; the use of social networks for educational processes — the patient’s family, training of first-contact doctors.

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Predictors of poor outcome in children with steroid sensitive nephrotic syndrome

Abstract: Adequate 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.

Cited by 5 publications

References 15 publications

Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Incidence and Relapse of Idiopathic Nephrotic Syndrome: Meta-analysis

A child with newly diagnosed kidney disease and his family: determination of early factors of disease progression and features of nephroprotection

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