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.

Study design

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.

Conclusion

The interval from onset of steroid therapy to remission is an accurate early prognostic factor in INS.

AUC, Area under the curve, CsA, Cyclosporin A, CYP, Cyclophosphamide, FR, Frequent relapsing, HR, Hazard ratio, INS, Idiopathic nephrotic syndrome, IR, Infrequent relapsing, ISKDC, International Study of Kidney Disease in Children, NR, Non-relapsing, NS, Nephrotic syndrome, OR, Odds ratio, PDN, Prednisone, PPV, Positive predictive value, ROC, Receiver operating curves, SD, Steroid-dependent