Disease course in steroid sensitive nephrotic syndrome.
OBJECTIVE
To review the disease course in patients with steroid sensitive nephrotic syndrome (SSNS) and the factors that determine outcome


METHODS
Retrospective, analytical


METHODS
Pediatric Nephrology Clinic at referral center in North India


METHODS
All patients with SSNS evaluated between 1990 and 2005 INTERVENTION: None


METHODS
Disease course, in patients with at least 1-yr follow up, was categorized as none or infrequent relapses (IFR), frequent relapses or steroid dependence (FR), and late resistance. Details on complications and therapy with alternative agents were recorded.


RESULTS
Records of 2603 patients (74.8% boys) were reviewed. The mean age at onset of illness and at evaluation was 49.7±34.6 and 67.5±37.9 months respectively. The disease course at 1-yr (n=1071) was categorized as IFR in 37.4%, FR in 56.8% and late resistance in 5.9%. During follow up, 224 patients had 249 episodes of serious infections. Alternative medications for frequent relapses (n=501; 46.8%) were chiefly cyclophosphamide and levamisole. Compared to IFR, patients with FR were younger (54.9±36.0 vs. 43.3±31.4 months), fewer had received adequate (=8 weeks) initial treatment (86.8% vs. 81.7%) and had shorter initial remission (7.5±8.6 vs. 3.1±4.8 months) (all P<0.001). At follow up of 56.0±42.6 months, 77.3% patients were in remission or had IFR, and 17.3% had FR.


CONCLUSIONS
A high proportion of patients with SSNS show frequent relapses, risk factors for which were an early age at onset, inadequate initial therapy and an early relapse.
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Aditi
A
Sinha
Pankaj
P
Hari
Piyush Kumar
PK
Sharma
Ashima
A
Gulati
Mani
M
Kalaivani
Mukta
M
Mantan
Amit Kumar
AK
Dinda
Rajendra N
RN
Srivastava
Arvind
A
Bagga
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D011239:Prednisolone / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome
D013256:Steroids; D011239:Prednisolone