Steroid Responsiveness of Children with Idiopathic Nephrotic Syndrome in Southeastern Region of Turkey

Abstract

Background. Our aim was to determine the prognostic factors effective in the response to steroid treatment and relapse frequency. Patients and Methods. In this study, we evaluated 84 children with idiopathic nephrotic syndrome followed-up from 1997-2002. The variables were analyzed with respect to medical history, physical examination, laboratory findings, response to treatment, and factors associated with remissions and relapses. Our study group consisted of 62 children with minimal change nephrotic syndrome (MCNS), 11 children with focal segmental glomerulosclerosis (FSGS), and 11 children with diffuse mesangial proliferation (DMP). Results. According to response to steroids; 57.1% were steroid-sensitive with infrequent relapses, 22.6% were steroid-dependent with frequent relapses, and 20.2% were steroid-non-responders. Significantly high non-responder ratios to steroids were found in children with initial hypertension and hematuria (p < 0.05). Although patients older than six years were found to be associated with steroid nonresponse (p < 0.05), the number of relapses were found to be increased with an increasing number of infections (p < 0.05). The time period for the first relapse was found to be statistically correlated with relapse numbers of the first 6 (p = 0.001) and 12 (p = 0.01) months. Conclusion. The time span between initial presentation and remission and the number of infections were significant for relapse frequency. The existence of hematuria and hypertension and age greater than 6 years at initial presentation were associated with steroid non-responsiveness. The likelihood of developing resistance to the treatment should be emphasized early to the parents of patients bearing these risk factors, and hence the possible disappointment in the family should be prevented.

Long-term prognosis of idiopathic nephrotic syndrome in children

“…24 Relapses and resistance to steroids were observed in 75% of patients with hypertension in the study of Davutoglu et al 17 We also observed that hypertension was more frequent among the patients who are non-responsive to steroid therapy (32.8%). FSGS was more common in children who were hypertensive and who had microscopic hematuria at first visit and this was statistically significant (p50.05).…”

“…15,16 We used steroids for 14 weeks at the first attack and we did not observe severe side effects and the relapse rate was 69.9%. This rate was 32.1% in the study of Davutoglu et al 17 We attributed the high relapse rate in our study to the long-term follow-up of our patients.…”

“…5,17,[31][32][33][34][35] In our study population, 96% of steroid-responder patients went into complete remission; whereas only 46% of the steroid non-responder patients did. Moreover, none of the steroid responders developed CKD and ESRD while 11% of steroid non-responder patients developed CKD and 4.1% developed ESRD.…”

Clinical course & management of childhood nephrotic syndrome in Germany: a large epidemiological ESPED study

“…The overall trend is that children with bacterial infections are younger. Also, the number of the infections was mostly associated to the number of relapses of NS [14].…”

“…Arterial hypertension was observed in 34 of our patients (9.8%), who often had SRNS and FSGS, although no patient in this cohort had IUGR. Davutoglu et al similarly reported that children with AH were frequently more steroid-resistant [14]. Importantly, AH has rarely been observed in children with MCNS [18] but was more common in children with FSGS [19].…”