Two-Year Outcome of the ISKDC Regimen and Frequent-Relapsing Risk in Children with Idiopathic Nephrotic Syndrome

Abstract

SummaryBackground and objectives Early identification of frequently relapsing children with idiopathic nephrotic syndrome is desirable.Design, setting, participants, & measurements The relapse status and clinical data of patients previously registered (January of 1993 to December of 2001) in a multicenter prospective study of the International Study of Kidney Disease in Children regimen were analyzed for risk of frequent relapsers over a 2-year follow-up period.Results Of 166 children with nephrotic syndrome (113 boys and 53 girls; median age=5.1 years), 145 (87.3%, median age=5.5 years) children were steroid-sensitive, and 21 (12.7%, median age=2.9 years) children were steroid-resistant. Of 145 children with steroid-sensitive nephrotic syndrome, 32 (22.1%, median age=4.2 years) children experienced frequent relapses over 2 years. The time to initial response was significantly longer (10 versus 7 days, P,0.001, log-rank test) in the 32 frequent relapsers than in the 106 nonfrequent relapsers. The time from start of initial treatment to first relapse was significantly shorter (2.6 versus 6.1 months, P,0.001, log-rank test) in the 32 frequent relapsers than in the 57 infrequent relapsers. In a Cox regression model, the time to initial response $9 days and the duration from start of initial treatment to first relapse ,6 months were significant predictors of frequent relapses (unadjusted and adjusted).Conclusions Initial remission time $9 days and first relapse within 6 months were associated with frequent relapses. These findings may also be useful also in selecting potential frequent relapsers for clinical trials.

Predictors of frequent relapsing and steroid-dependent nephrotic syndrome in children

“…Bazı çalışmalar, SR ya da SB nefrotik sendrom açısından yüksek riskle ilişkili hasta özelliklerini belirlemeye çalışmıştır, ama sonuçlar çelişkili bulunmuştur (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Mycophenolate mofetil is inferior to tacrolimus in sustaining remission in children with idiopathic steroid-resistant nephrotic syndrome

“…2 The reasons for an unfavorable course in patients who relapse during initial therapy with tacrolimus are also not clear. Although occurrence of a relapse within 6 months of onset of nephrotic syndrome is considered a risk factor for frequent relapses, 44,45 these findings are not noted in subjects with steroid resistance. Our observations perhaps define a subgroup of patients with steroid resistance who are likely to have an unsatisfactory course and require intensive treatment.…”

Frequency of relapse among Nigerian children with steroid-sensitive nephrotic syndrome

“…[2,13,14] We envisage that the longer course of prednisolone and larger cumulative dose employed in the present study may have contributed to the lower frequency of relapse, although two recent randomized control trials involving Asian children suggest otherwise. [10,11,[15][16][17] Furthermore, differences between the epidemiology of NS in different races mean the effect of race could be a possible explanation for the differences. [8,18] There is a need for more studies to confirm or refute this finding.…”

“…[7,8] Similarly, while young age, longer time to remission, and shorter duration of steroid-therapy have been associated with relapses in Caucasian and Asian children with SSNS, little is known about the predictors of relapses in black children with SSNS. [9][10][11] This study was undertaken to describe the clinical course of SSNS in a cohort of Nigerian children in Lagos and also to identify factors associated with subsequent relapses.…”