Triggers of relapse in steroid-dependent and frequently relapsing nephrotic syndrome.
An awareness of the triggers of relapse is critical for the control of steroid-dependent, frequently relapsing nephrotic syndrome (SDFRNS). We have investigated the triggers, usually described as 'episodes', to such relapses within a temporal context. Thirty-five patients with SDFRNS were analyzed retrospectively. A total of 442 relapses occurred in 2499 patient-months. The relapses were classified into two groups: those with episodes (E+) and those without episodes (E-). There were 135 E+ relapses and 296 E- relapses. The common cold was the most common episode (52%) of E+ relapse, followed by school events (18%). These E+ relapses occurred almost evenly throughout the 4 weeks between each follow-up visit. Conversely, 161 (55%) of the 296 E-z relapses occurred within the 3-day period preceding the patient's appointment (relapse-related hospital visit, RRHV). McNemar's test revealed that the concentration of relapses in this period was statistically significant (P < 0.00011). In addition, 15 out of 26 RRHV without additional therapy showed a spontaneous remission. From a chronological perspective, the common cold and school events as well as up-coming hospital visits may trigger relapses in SDFRNS patients.
Takahashi
Shori
S
Department of Pediatrics, Nihon University School of Medicine, 1-8-13 Chiyoda Ward, Kandasurugadai, Tokyo, 101-8309, Japan. shori@med.nihon-u.ac.jp
Wada
Naohiro
N
Murakami
Hitohiko
H
Funaki
Satoshi
S
Inagaki
Tetsuji
T
Harada
Kensuke
K
Nagata
Michio
M
D000293:Adolescent; D000553:Ambulatory Care; D000846:Anniversaries and Special Events; D002648:Child; D002675:Child, Preschool; D003139:Common Cold / Q000150:complications; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000503:physiopathology* / Q000523:psychology*; D012008:Recurrence; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use; D013312:Stress, Physiological / Q000150:complications*
D013256:Steroids