Risk Factors for Relapse in Childhood Nephrotic Syndrome

Minimal change nephrotic syndrome is the most common cause of the glomerular disease in children. Despite its high initial response to corticosteroids, relapses are common leading to increased morbidity. Therefore, appraisal of common triggers of relapse becomes an imperative for successful management of childhood nephrotic syndrome. The objective of the study was to identify the risk factors for frequent relapse in childhood nephrotic syndrome. This descriptive cross-sectional study was conducted in the department of Paediatrics, Rangpur Medical College Hospital, Bangladesh from January 2013 to December 2014. A total of 60 patients with relapsed idiopathic childhood nephrotic syndrome fulfilling the selection criteria were enrolled into the study. Serum total protein, serum albumin and urine culture were done. The following potential risk factors for relapse were analyzed using Chi-square test: age at onset of NS, sex, socioeconomic status, atopy, short duration of initial therapy with steriod, serum total protein, serum albumin level and infection. Among 60 patients, short duration of therapy with steriod (<8 weeks) for first attack was significantly higher among frequent relapse (FRNS) cases compared with infrequent relapse (IFRNS) group (63% vs. 27.27%). FRNS group had initial brief period of remission of <6 months, (p=0.04). Difference in mean serum albumin and that of serum total protein between FRNS and IFRNS cases was (1.0±0.66 vs. 2.66±1.6gm/dl) (p<0.0001) and (3.5±1.2 vs. 6.5±2.12gm/dl) (p<0 .0001) respectively. This study concluded that short initial therapy with corticosteroid, brief duration of initial remission; low serum total protein and decreased serum albumin were the risk factors for frequent relapses.