American Journal of Medical and Biological Research. 2016, 4(1), 10-12
DOI: 10.12691/AJMBR-4-1-3
Original Research

Risk Factor of Frequent Relapse in Pediatric Nephrotic Syndrome

Desman Situmorang1, , Nanan Sekarwana1 and Eddy Fadlyana1

1Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia

Pub. Date: April 07, 2016

Cite this paper

Desman Situmorang, Nanan Sekarwana and Eddy Fadlyana. Risk Factor of Frequent Relapse in Pediatric Nephrotic Syndrome. American Journal of Medical and Biological Research. 2016; 4(1):10-12. doi: 10.12691/AJMBR-4-1-3

Abstract

Background. Nephrotic syndrome (NS) is a kidney disease with high incidence. Although steroids therapy produces a good outcome with remission (80−95%), but the relapse rates are also high (60-90%). Relapsed NS patients experienced a long period treatment and become dependent on steroids, which might cause side effects such as short stature, overweight, osteoporosis, and cardiovascular disease. Some risk factors of relapse are age, late remission, first relapsed ≤6 months after remission, and short initial therapy. Study design. A cross-sectional study with retrospective data collection from medical record of patients with frequent and infrequent relapse nephrotic syndrome from January 2010 to December 2014. There were 90 patients which were divided in two groups, 45 frequent relapse and 45 infrequent relapse. Statistical analysis used bivariate and multivariate risk factor. Result. Boys:girls ratio was 4.6:1, with median age is 5 years and 5 month (65 months). From bivariate analysis, the first diagnosis ≤5 years (p<0.001) and time on remission ≤6 month (p<0.001) were the risk factor of frequent relapse. Multivariate analysis showed time on remission ≤6 month (OR 37.113, CI 95% (7.115−193.595)) more significant than the age at diagnosis ≤5 years (OR 8.0 CI 95% (2.402−26.645)) upon frequent relapse nephrotic syndrome. Conclusion. Time on remission ≤6 month and the age at diagnosis of NS ≤5 years were risk factor of frequent relapse in nephrotic syndrome patients.

Keywords

Nephrotic syndrome, frequent relapse, risk factor.

Copyright

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References

[1]  Bagga A, Mantan M. Nephrotic syndrome in children. Indian J Med Res. 2005; 122(1):13-28.
 
[2]  Roth KS, Amaker BH, Chan JCM. Nephrotic syndrome: Pathogenesis and management. Pediatr Rev. 2002;23(7):237-48.
 
[3]  Konsensus tata laksana sindrom nefrotik idiopatik pada anak. 2nd Edition. Jakarta: UKK Nefrologi IDAI; 2008.
 
[4]  Pais P, Avner ED. Nephrotic syndrome. In: Kliegman RM, Stanton BF, III JWSG, Shor NF, Editor. Nelson textbook of pediatrics. 19th Edition. Philadelphia: Elsevier; 2011. p. 6483-8.
 
[5]  Teeninga N, Holthe JEK-v, Rijswijk Nv, Mos NId, Hop WCJ, Wetzels JFM, et al. Extending prednisolone treatment does not reduce relapses in childhood nephrotic syndrome. J Am Soc Nephrol. 2013;24:149-59.
 
[6]  Sarker MN, Islam MMSU, Saad T, Shoma FN, Sharmin LS, Khan HA, et al. Risk factor for relapse in childhood nephrotic syndrome - a hospital based retrospective study. Faridpur Med Coll J. 2012;7(1):18-22.
 
[7]  ISKDC. Early identification of frequent relapsers among children with minimal change nephrotic syndrome. A report of the international study of kidney disease in children. J Pediatr. 1982;101(4):514-8.
 
[8]  Salloum AAA, Muthanna A, Bassrawi R, Shehab AAA, Ibrahim AA, Islam MZ, et al. Long-term outcome of the difficult nephrotic syndrome in children. Saudi J Kidney Dis Transpl. 2012;23(5):965-72.
 
[9]  Niaudet P. Long-term outcome of children with steroid-sensitive idiopathic nephrotic syndrome. Clin J Am Soc Nephrol. 2009;4:1547-8.
 
[10]  Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy, asthma & clinical immunology. 2013;9(30):1-25.
 
[11]  Garniasih D, Djais JTB, Garna H. Hubungan antara kadar albumin dan kalsium serum pada sindrom nefrotik anak. Sari Pediatri. 2008;10(2):100-5.
 
[12]  Niaudet P, Boyer O. Idiopathic nephrotic syndrome in children: Clinical aspects. In: Avner E, Harmon W, Niaudet P, Yoshikawa N, editor. Pediatric nephrology. Edisi ke-6. Berlin: Springer; 2009. hlm. 667-702.
 
[13]  Uwaezuoke SN. Steroid-sensitive nephrotic syndrome in children: Triggers of relapse and evolving hypotheses on pathogenesis. Italian Journ of Ped. 2015;41(19):1-6.
 
[14]  Constantinescu AR, Shah HB, Foote EF, Weiss LS. Predicting first-year relapses in children with nephrotic syndrome. Pediatrics. 2000;105:492-5.
 
[15]  Shin HK, Kim JH, Yoo KH, Hong YS, Lee JW, Kim SK. Risk factor for the first-year relapse in children with nephrotic syndorome. J Korean Pediatr Soc. 2003;46:889-92.
 
[16]  Meyers KEC, Kajubu DA, Kaplan BS. Minimal-change nephrotic syndrome. In: Neilson EG, Couser WG, editor. Immunologic renal disease. Edisi. Philadelphia: Lippincot-Raven; 1997. hlm. 975-92.
 
[17]  Sureshkumar P, Hodson EM, Willis NS, Barzi F, Craig JC. Predictors of remission and relapse in idiopathic nephrotic syndrome: A prospective cohort study. Pediatr Nephrol. 2014;29:1039-46.
 
[18]  Takeda A, Matsutani H, Niimura F, Ohgushi H. Risk factors for relapse in childhood nephrotic syndrome. Pediatr Nephrol. 1996;10:740-1.