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Prediction of subsequent relapse in children with steroid-sensitive nephrotic syndrome
A Takeda1, H Takimoto, Y Mizusawa
1Kidney Center, Tsuchiura Kyodo General Hospital, 11-7, Manabe shinmachi, Tsuchiura-shi, Ibaraki-ken, 300-0053, Japan. takedas@d5.dion.ne.jp
Insights
Early relapse in childhood nephrotic syndrome predicts future relapses, especially within the first year. Shorter remission periods also increase relapse risk, informing treatment decisions for steroid-sensitive cases.
Area of Science:
- Pediatric Nephrology
- Clinical Epidemiology
Background:
- Steroid-sensitive nephrotic syndrome (SSNS) frequently relapses in children.
- Identifying children at high risk for subsequent relapses is crucial for managing steroid toxicity and considering cytotoxic therapy.
Purpose of the Study:
- To identify risk factors for subsequent relapses in children with SSNS.
- To inform decisions regarding the initiation of cytotoxic drugs.
Main Methods:
- A Cox proportional-hazards regression model was used.
- Analyzed clinical data from 121 children with SSNS, encompassing 467 relapses.
- Evaluated factors including age, gender, duration of illness, steroid dosage, and remission periods.
Main Results:
- Relapse within the first year of illness was a significant independent predictor of subsequent relapses (hazard ratio 1.72-2.12).
- A longer remission period (≥1 year) before the most recent relapse decreased subsequent relapse risk (hazard ratio 0.57).
- Cyclophosphamide treatment showed a trend towards longer remission compared to prednisolone alone.
Conclusions:
- Early relapse and short remission periods are key independent risk factors for subsequent relapses in childhood SSNS.
- These findings aid in selecting patients who may benefit from early intervention with cytotoxic agents, balancing efficacy against potential adverse effects.
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.