Predictors of remission and relapse in idiopathic nephrotic syndrome: a prospective cohort study

Pediatr Nephrol. 2014 Jun;29(6):1039-46. doi: 10.1007/s00467-013-2736-9. Epub 2014 Feb 2.

Abstract

Background: Although most children with idiopathic nephrotic syndrome will respond to corticosteroid therapy, 80-90 % suffer one or more relapses.

Methods: Using Cox proportional hazard models, we analyzed predictors of remission and relapse in 1-year follow-up data on children aged below 15 years with new-onset nephrotic syndrome.

Results: Of 129 children, 107 achieved remission with corticosteroid therapy and 86 subsequently relapsed. Boys achieved remission more often than girls (adjusted hazard ratio [AHR] 1.52, 95 % confidence interval (CI) 1.02-2.3). Boys relapsed significantly more frequently than girls (AHR 1.77, 95 % CI 1.11-2.83) and were more likely to have frequently relapsing disease (AHR 3.3, 95 % CI 1.18-9.23). The risk of first relapse increased with the number of days to first remission (AHR 1.02, 95 % CI 1.01-1.04). The risk for a frequently relapsing course increased with a shorter time from remission to first relapse (AHR 0.92, 95 % CI 0.87-0.97).

Conclusions: In idiopathic nephrotic syndrome, boys are more likely to respond initially, more likely to relapse, and to be classified as having frequently relapsing nephrotic syndrome. A decrease in time from remission to first relapse predicts for a frequently relapsing course.

MeSH terms

  • Adolescent
  • Anti-Inflammatory Agents / therapeutic use
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Glucocorticoids / therapeutic use
  • Humans
  • Infant
  • Male
  • Nephrotic Syndrome / drug therapy*
  • Nephrotic Syndrome / pathology*
  • Prednisone / therapeutic use
  • Pregnenediones / therapeutic use
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Recurrence
  • Treatment Outcome

Substances

  • Anti-Inflammatory Agents
  • Glucocorticoids
  • Pregnenediones
  • Prednisone

Supplementary concepts

  • Nephrosis, congenital