Predictors of remission and relapse in idiopathic nephrotic syndrome: a prospective cohort study
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Although most children with idiopathic nephrotic syndrome will respond to corticosteroid therapy, 80–90 % suffer one or more relapses.
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.
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).
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.
KeywordsChildhood nephrotic syndrome Cohort study Remission Relapse
This study was performed using case ascertainment through the Australian Paediatric Surveillance Unit (APSU). The activities of the APSU are supported by the National Health and Medical Research Council of Australia (Enabling Grant no. 402784 and Practitioner Fellowship No 1021480: E. Elliott); the Australian Government Department of Health and Ageing; the Sydney Medical School, The University of Sydney and the Royal Australasian College of Physicians. The authors would like to thank all Australian pediatricians who participated in APSU surveillance, reported cases, and completed questionnaires on their patients. The study was funded in part by Kidney Health Australia. Kidney Health Australia had no involvement in the design, data collection, data analysis or writing of the manuscript.
Parts of this study were presented at the 13th Congress of the International Pediatric Nephrology Association, August 29 to September 2 2004, Adelaide, Australia, and were published in abstract form.
The authors would like to thank Mrs. Sandra Puckeridge and Dr. Jeffrey Fletcher for their assistance with data collection and for the preliminary analyses of the data. The authors would also like to thank the Australian members of the Australia and New Zealand Paediatric Nephrology Association, who reviewed the protocol and questionnaires for this study.
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