Auditory function in pediatric idiopathic nephrotic syndrome: Correlations with disease severity and corticosteroid...

To evaluate the prevalence and nature of hearing dysfunction in children with idiopathic nephrotic syndrome (INS) using objective audiological modalities, and to correlate findings with disease status, cumulative corticosteroid dose, and relapse frequency.

Prospective cross-sectional study.

Department of ENT and Head and Neck Surgery and Department of Pediatric Nephrology, Kasturba Medical College, MAHE, Manipal, India.

Twenty-one children aged 2-18 years with confirmed INS were enrolled between March 2024 and March 2026. All participants underwent distortion product otoacoustic emissions (DP-OAE) testing and, where cooperation permitted, auditory brainstem response (ABR) testing. Patients were stratified into three disease groups: newly diagnosed (n = 3), in relapse (n = 7), and in remission (n = 11). Hearing outcomes were compared across groups and correlated with cumulative corticosteroid dose (in milligrams) and relapse frequency using Spearman's rank correlation coefficient.

Two of 21 children (9.52%) demonstrated hearing abnormalities. Both were in the remission group (18.2% within this subgroup). DP-OAE revealed subclinical cochlear dysfunction in 2 of 21 children (9.52%). ABR confirmed abnormalities in the same 2 children (2/18, 11.11%) with 100% inter-modality concordance. Both abnormal cases were in the remission group, had multiple relapses (4 and 6 lifetime relapses), and high cumulative corticosteroid exposure (5200 mg and 24,456 mg). Neither child nor parent reported hearing difficulty; otological examination was normal in both. ABR confirmed cochlear origin with no retrocochlear pathology. Relapse frequency strongly correlated with cumulative steroid dose (Spearman ρ = 0.896, p < 0.001).

Subclinical cochlear dysfunction is present in a subset of children with INS and is undetectable by routine clinical examination. The findings are consistent with shared renal-cochlear vulnerability and cumulative corticosteroid-associated cochlear toxicity. Objective hearing screening should be integrated into standard follow-up protocols for pediatric nephrotic syndrome.