Pediatric Nephrology

, Volume 31, Issue 12, pp 2299–2308 | Cite as

Epidemiology of idiopathic nephrotic syndrome in children: endemic or epidemic?

  • Claire DossierEmail author
  • Nathanael Lapidus
  • Florian Bayer
  • Anne-Laure Sellier-Leclerc
  • Olivia Boyer
  • Loic de Pontual
  • Adrien May
  • Sylvie Nathanson
  • Christine Orzechowski
  • Tabassome Simon
  • Fabrice Carrat
  • Georges Deschênes
Original Article



The etiology of idiopathic nephrotic syndrome (INS) remains partially unknown. Viral infections have been reported to be associated with INS onset and relapse. The aim of this study was to describe the epidemiology of a population-based cohort of children with INS and propose a spatiotemporal analysis.


All children aged 6 months to 15 years with INS onset between December 2007 and May 2010 and living in the Paris area were included in a prospective multicenter study. Demographic and clinical features at diagnosis and 2 years were collected.


INS was diagnosed in 188 children, 93 % of whom were steroid sensitive. Annual incidence was 3.35/100,000 children. Standardized incidence ratio (SIR) was higher in one of the eight counties: Seine-Saint-Denis, with SIR 1.43 [95 % confidence interval (CI) 1.02–1.95]. A spatial cluster was further identified with higher SIR 1.36 (95 % CI 1.09–1.67). Temporal analysis within this overincidence area showed seasonal variation, with a peak during the winter period (p <0.01). In addition, partition of the Paris area into quintiles of the population showed that the average delay of occurrence, with regard to the first study case, followed a longitudinal progression (p <0.0001).


The clustering of cases, the seasonal variation within this particular area, and the progression over the Paris area altogether suggest that INS may occur on an epidemic mode.


Nephrotic syndrome Childhood Epidemiology Cluster Seasonal periodicity 


Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical statement

The study was reviewed and accepted by the local ethic committee. A written informed consent was systematically signed by the parents and, when possible, by the patient (age >10 years).


  1. 1.
    Yap HK, Han EJ, Heng CK, Gong WK (2001) Risk factors for steroid dependency in children with idiopathic nephrotic syndrome. Pediatr Nephrol 16:1049–1052CrossRefPubMedGoogle Scholar
  2. 2.
    Toyabe S, Nakamizo M, Uchiyama M, Akazawa K (2005) Circannual variation in the onset and relapse of steroid-sensitive nephrotic syndrome. Pediatr Nephrol 20:470–473CrossRefPubMedGoogle Scholar
  3. 3.
    Odaka J, Kanai T, Uehara R, Kusano E, Yamagata T (2015) Seasonal variation in first episode of childhood idiopathic steroid-sensitive nephrotic syndrome and adult minimal change nephrotic syndrome. Clin Exp Nephrol 19:146–147CrossRefPubMedGoogle Scholar
  4. 4.
    Hodson E, Craig J, Willis N (2002) Congenital and idiopathic nephrotic syndrome. In: Ninth Annual Report Australian Paediatric Surveillance Unit. Eliott E, Australia, pp 6–8Google Scholar
  5. 5.
    Wong W (2007) Idiopathic nephrotic syndrome in New Zealand children, demographic, clinical features, initial management and outcome after twelve-month follow-up: results of a three-year national surveillance study. J Paediatr Child Health 43:337–341CrossRefPubMedGoogle Scholar
  6. 6.
    El Bakkali L, Rodrigues Pereira R, Kuik DJ, Ket JC, van Wijk JA (2011) Nephrotic syndrome in The Netherlands: a population-based cohort study and a review of the literature. Pediatr Nephrol 26:1241–1246CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Chuan PL, Leng SC, Sinniah R (1975) Five-year review of nephrotic syndrome in Singapore children. J Singapore Paediatr Soc 17:113–123PubMedGoogle Scholar
  8. 8.
    Sharples PM, Poulton J, White RH (1985) Steroid responsive nephrotic syndrome is more common in Asians. Arch Dis Child 60:1014–1017CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    McKinney PA, Feltbower RG, Brocklebank JT, Fitzpatrick MM (2001) Time trends and ethnic patterns of childhood nephrotic syndrome in Yorkshire, UK. Pediatr Nephrol 16:1040–1044CrossRefPubMedGoogle Scholar
  10. 10.
    Feehally J, Kendell NP, Swift PG, Walls J (1985) High incidence of minimal change nephrotic syndrome in Asians. Arch Dis Child 60:1018–1020CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Schlesinger ER, Sultz HA, Mosher WE, Feldman JG (1968) The nephrotic syndrome. its incidence and implications for the community. Am J Dis Child 116:623–632CrossRefPubMedGoogle Scholar
  12. 12.
    French National Authority for Health (2008) Idiopathic nephrotic syndrome in children. French National Authority for Health: 1–22Google Scholar
  13. 13.
    Azib S, Macher MA, Kwon T, Dechartres A, Alberti C, Loirat C, Deschênes G, Baudouin V (2011) Cyclophosphamide in steroid-dependent nephrotic syndrome. Pediatr Nephrol 26:927–932CrossRefPubMedGoogle Scholar
  14. 14.
    Dossier C, Sellier-Leclerc A-L, Rousseau A, Michel Y, Gautheret-Dejean A, Englender M, Madhi F, Charbit M, Ulinski T, Simon T, Jacqz-Aigrain E, Deschênes G (2014) Prevalence of herpesviruses at onset of idiopathic nephrotic syndrome. Pediatr Nephrol 29:2325–2331CrossRefPubMedGoogle Scholar
  15. 15.
    Tripepi G, Jager KJ, Dekker FW, Zoccali C (2010) Stratification for confounding--part 2: direct and indirect standardization. Nephron Clin Pract 116:c322–c325CrossRefPubMedGoogle Scholar
  16. 16.
    Breslow N, Day N (1993) Statistical methods in cancer research: the design and analysis of cohort studies. Int Agency Res Cancer: 406Google Scholar
  17. 17.
    Johnson SC (1967) Hierarchical clustering schemes. Psychometrika 32:241–254CrossRefPubMedGoogle Scholar
  18. 18.
    Levine N (2013) CrimeStat IV: A spatial statistics program for the analysis of crime incident locations (version 4.0). Houston, TX, and the National Institute of Justice, Washington DCGoogle Scholar
  19. 19.
    Mitchell A (2005) The ESRI guide to GIS analysis. VOlume 2 : spatial measurements and statisticsGoogle Scholar
  20. 20.
    Bithell JF (1990) An application of density estimation to geographical epidemiology. Stat Med 9:691–701CrossRefPubMedGoogle Scholar
  21. 21.
    De Smith M, Goodchild M, Longley P (2007) Geospatial analysis : a comprehensive guide to principles, techniques and software tools. Troubadour Publishing LtdGoogle Scholar
  22. 22.
    Larmarange J, Vallo R, Yaro S, Msellati P, Méda N (2011) Methods for mapping regional trends of HIV prevalence from demographic and health surveys (DHS). Cybergeo : Europ J Geography 2011:558Google Scholar
  23. 23.
    Chang J-W, Tsai H-L, Yang L-Y, Chen T-J (2012) Epidemiology and predictors of end-stage renal disease in Taiwanese children with idiopathic nephrotic syndrome. J Epidemiol 22:517–522CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Swaroop S (1957) Index of endemicity. Bull World Health Organ 16:1083–1101PubMedPubMedCentralGoogle Scholar
  25. 25.
    Kalra S, Kumar A, Jarhyan P, Unnikrishnan AG (2015) Endemic or epidemic? measuring the endemicity index of diabetes. Indian J Endocrinol Metab 19:5–7CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    MacDonald NE, Wolfish N, McLaine P, Phipps P, Rossier E (1986) Role of respiratory viruses in exacerbations of primary nephrotic syndrome. J Pediatr 108:378–382CrossRefPubMedGoogle Scholar
  27. 27.
    Blanchoud H, Farrugia F, Mouchel JM (2004) Pesticide uses and transfers in urbanised catchments. Chemosphere 55:905–913CrossRefPubMedGoogle Scholar
  28. 28.
    Colosio C, Corsini E, Barcellini W, Maroni M (1999) Immune parameters in biological monitoring of pesticide exposure: current knowledge and perspectives. Toxicol Lett 108:285–295CrossRefPubMedGoogle Scholar
  29. 29.
    Vidotto JP, Pereira LA, Braga AL, Silva CA, Sallum AM, Campos LM, Martins LC, Farhat SC (2012) Atmospheric pollution: influence on hospital admissions in paediatric rheumatic diseases. Lupus 21:526–533CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2016

Authors and Affiliations

  • Claire Dossier
    • 1
    Email author
  • Nathanael Lapidus
    • 2
    • 3
  • Florian Bayer
    • 4
  • Anne-Laure Sellier-Leclerc
    • 5
  • Olivia Boyer
    • 6
  • Loic de Pontual
    • 7
  • Adrien May
    • 8
  • Sylvie Nathanson
    • 9
  • Christine Orzechowski
    • 10
  • Tabassome Simon
    • 11
  • Fabrice Carrat
    • 2
    • 3
  • Georges Deschênes
    • 1
  1. 1.Service de Néphrologie PédiatriqueHôpital Robert-Debré, APHPParisFrance
  2. 2.Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136)ParisFrance
  3. 3.Department of Public HealthHôpital Saint-Antoine, AP-HPParisFrance
  4. 4.Agence de la BiomédecineSaint-Denis La PlaineParisFrance
  5. 5.Service de Néphrologie PédiatriqueHospices Civiles de LyonLyonFrance
  6. 6.Service de Néphrologie PédiatriqueNecker-Enfants-Malades, APHPParisFrance
  7. 7.Service de PédiatrieHôpital Jean-Verdier, APHPBondyFrance
  8. 8.Service de PédiatrieCentre Hospitalier Sud FrancilienCorbeil-EssonneFrance
  9. 9.Service de PédiatrieCentre Hospitalier de VersaillesLe ChesnayFrance
  10. 10.Service de PédiatrieHôpital Saint-Camille Bry-sur-MarneLe ChesnayFrance
  11. 11.Unité de Recherche Clinique URC-EstUniversité Paris 6ParisFrance

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