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Predictors of remission and relapse in idiopathic nephrotic syndrome: a prospective cohort study
Premala Sureshkumar1, Elisabeth M Hodson, Narelle S Willis
1Centre for Kidney Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW 2145, Australia.
Insights
Boys with idiopathic nephrotic syndrome respond well to steroids but are more prone to relapses and frequently relapsing disease. Shorter remission to relapse times predict a frequently relapsing course.
Area of Science:
- Pediatric Nephrology
- Clinical Pediatrics
- Internal Medicine
Background:
- Idiopathic nephrotic syndrome (INS) affects children, with most responding to corticosteroid therapy.
- However, a significant majority (80-90%) experience one or more relapses.
Purpose of the Study:
- To analyze predictors of remission and relapse in children with new-onset INS.
- To identify factors influencing disease course and frequency of relapses.
Main Methods:
- Cox proportional hazard models were used for analysis.
- Data from 129 children under 15 years with new-onset INS were analyzed.
- Follow-up data covered a 1-year period.
Main Results:
- 107 out of 129 children achieved remission with corticosteroids.
- Boys achieved remission more often than girls (AHR 1.52).
- Boys relapsed more frequently (AHR 1.77) and were more likely to have frequently relapsing disease (AHR 3.3).
- Increased time to first remission correlated with higher risk of first relapse (AHR 1.02).
- Shorter time from remission to first relapse predicted a frequently relapsing course (AHR 0.92).
Conclusions:
- Boys with INS show higher initial response rates but are more prone to relapse.
- Boys are more likely to be classified with frequently relapsing nephrotic syndrome.
- The time interval between remission and the first relapse is a key predictor for disease recurrence patterns.
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.
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