Time for initial response to steroids is a major prognostic factor in idiopathic nephrotic syndrome.
OBJECTIVE
To identify early prognostic factors for idiopathic nephrotic syndrome (INS) in childhood.


METHODS
A retrospective analysis of 103 patients with INS at onset, all treated in a single center with the same induction protocol, was conducted. Minimum length of follow-up was 2 years; median length of follow-up was 43 months. Survival data were assessed with Cox-Mantel analysis. Predictive values were estimated with receiver operating characteristic curves.


RESULTS
The median time of response to steroid therapy was 7 days. A significant association was found between the interval from onset of steroid therapy to remission and the risk of relapsing within 3 months after steroid therapy discontinuation (P < .0001). A similar association was found between the time to achieve remission and the risk of developing frequent relapsing or steroid-dependent nephrotic syndrome (P < .0001), the prescription of maintenance steroid therapy (P < .003), and the prescription of all other non-steroid drugs (P < .0001) during follow-up. Patients with non-relapsing and infrequent relapsing nephrotic syndrome had a median time to achieve remission <7 days; in patients with frequent relapsing and steroid-dependent nephrotic syndrome, this median was >7 days.


CONCLUSIONS
The interval from onset of steroid therapy to remission is an accurate early prognostic factor in INS.
Vivarelli
Marina
M
Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
Moscaritolo
Eleonora
E
Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
Tsalkidis
Aggelos
A
Department of Pediatrics, University Hospital of Alexandroupolis, Democritus University of Thrace-Medical School, Alexandroupolis, Greece.
Massella
Laura
L
Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
Emma
Francesco
F
Division of Nephrology and Dialysis, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D011241:Prednisone / Q000627:therapeutic use*; D011379:Prognosis; D012372:ROC Curve; D012074:Remission Induction; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011241:Prednisone