Two-year outcome of the ISKDC regimen and frequent-relapsing risk in children with idiopathic nephrotic syndrome.
OBJECTIVE
Early identification of frequently relapsing children with idiopathic nephrotic syndrome is desirable.


METHODS
The relapse status and clinical data of patients previously registered (January of 1993 to December of 2001) in a multicenter prospective study of the International Study of Kidney Disease in Children regimen were analyzed for risk of frequent relapsers over a 2-year follow-up period.


RESULTS
Of 166 children with nephrotic syndrome (113 boys and 53 girls; median age=5.1 years), 145 (87.3%, median age=5.5 years) children were steroid-sensitive, and 21 (12.7%, median age=2.9 years) children were steroid-resistant. Of 145 children with steroid-sensitive nephrotic syndrome, 32 (22.1%, median age=4.2 years) children experienced frequent relapses over 2 years. The time to initial response was significantly longer (10 versus 7 days, P<0.001, log-rank test) in the 32 frequent relapsers than in the 106 nonfrequent relapsers. The time from start of initial treatment to first relapse was significantly shorter (2.6 versus 6.1 months, P<0.001, log-rank test) in the 32 frequent relapsers than in the 57 infrequent relapsers. In a Cox regression model, the time to initial response ≥9 days and the duration from start of initial treatment to first relapse <6 months were significant predictors of frequent relapses (unadjusted and adjusted).


CONCLUSIONS
Initial remission time ≥9 days and first relapse within 6 months were associated with frequent relapses. These findings may also be useful also in selecting potential frequent relapsers for clinical trials.
Department of Pediatrics, Wakayama Medical University, Wakayama, Japan. knakanis@wakayama-med.ac.jp
Koichi
K
Nakanishi
Kazumoto
K
Iijima
Kenji
K
Ishikura
Hiroshi
H
Hataya
Hitoshi
H
Nakazato
Satoshi
S
Sasaki
Masataka
M
Honda
Norishige
N
Yoshikawa
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D009404:Nephrotic Syndrome / Q000151:congenital* / Q000175:diagnosis / Q000188:drug therapy; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D011239:Prednisolone