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Abstract

BACKGROUND:   Patients with idiopathic nephrotic syndrome are usually steroid sensitive, however about 50% of relapsed children who experienced frequent relapses, develop steroid-dependency and become vulnerable for complications of long-term use of steroid. OBJECTIVE: Early detection of risk factors in patients with a nephrotic syndrome that could make them more liable to have steroid dependency after initial response to treatment with steroid. PATIENTS AND METHOD: A hospital-based retrospective cross-sectional study of patients aged 1-16 years; Followed up for at least 6 months at the outpatient clinic of the pediatric nephrology unit in central child teaching hospital .The study group was divided into two groups, group A included 68 patients with infrequent relapses nephrotic syndrome and group B included 32 patients with steroid-dependent nephrotic syndrome. Data was collected from medical record of patients visiting our hospital from 1st. of January 2015 to 31st. of December 2017. RESULTS:  A sample of 100 patients participated in the current study; it shows that the male gender represents 51%, whereas the dependents patients on steroid occurred in 32% versus 68% infrequently relapse patients. It also shows the history of atopy (17%), microscopic hematuria (24%), hypoalbuminemia (79%), hypercholesterolemia (57%) and positive history of upper respiratory tract infection in 33%. It reveals that there was statistically significant (P0.015) association of steroid response with gender with a higher proportion of dependent patient in males than females. Also there was statistically significant association between steroid dependency and microscopic hematuria (P0.030) and between steroid dependency and history of upper respiratory tract infection (P0.043).While there were neither significant relationship with history of atopy nor with serum albumin level. There was a highly statistically significant (0.004) association with days of remission, higher proportion in more than 20 days, and highly statistically significant association of steroid dependency with hypercholesterolemia (0.001). Also there were significanthigher mean of days of remission in the dependent patient(P0.044), statistically significant higher mean of serum cholesterol (0.0005)and statistically significant higher mean of systolic and diastolic blood pressure(0.001 and 0.017 respectively). Finally there was a highly statistically significant difference in means according to the numbers of relapse with higher mean in dependent patients (0.002).  CONCLUSION: Prolong duration of first remission, hypertension, male gender, increasing number of relapse, microscopic Hematuria and history of infection of the upper respiratory tract have a high predictive value to be steroid dependent in children with nephrotic syndrome.                    BACKGROUND:   Patients with idiopathic nephrotic syndrome are usually steroid sensitive, however about 50% of relapsed children who experienced frequent relapses, develop steroid-dependency and become vulnerable for complications of long-term use of steroid. OBJECTIVE: Early detection of risk factors in patients with a nephrotic syndrome that could make them more liable to have steroid dependency after initial response to treatment with steroid. PATIENTS AND METHOD: A hospital-based retrospective cross-sectional study of patients aged 1-16 years; Followed up for at least 6 months at the outpatient clinic of the pediatric nephrology unit in central child teaching hospital .The study group was divided into two groups, group A included 68 patients with infrequent relapses nephrotic syndrome and group B included 32 patients with steroid-dependent nephrotic syndrome. Data was collected from medical record of patients visiting our hospital from 1st. of January 2015 to 31st. of December 2017. RESULTS:  A sample of 100 patients participated in the current study; it shows that the male gender represents 51%, whereas the dependents patients on steroid occurred in 32% versus 68% infrequently relapse patients. It also shows the history of atopy (17%), microscopic hematuria (24%), hypoalbuminemia (79%), hypercholesterolemia (57%) and positive history of upper respiratory tract infection in 33%. It reveals that there was statistically significant (P0.015) association of steroid response with gender with a higher proportion of dependent patient in males than females. Also there was statistically significant association between steroid dependency and microscopic hematuria (P0.030) and between steroid dependency and history of upper respiratory tract infection (P0.043).While there were neither significant relationship with history of atopy nor with serum albumin level. There was a highly statistically significant (0.004) association with days of remission, higher proportion in more than 20 days, and highly statistically significant association of steroid dependency with hypercholesterolemia (0.001). Also there were significanthigher mean of days of remission in the dependent patient(P0.044), statistically significant higher mean of serum cholesterol (0.0005)and statistically significant higher mean of systolic and diastolic blood pressure(0.001 and 0.017 respectively). Finally there was a highly statistically significant difference in means according to the numbers of relapse with higher mean in dependent patients (0.002).  CONCLUSION: Prolong duration of first remission, hypertension, male gender, increasing number of relapse, microscopic Hematuria and history of infection of the upper respiratory tract have a high predictive value to be steroid dependent in children with nephrotic syndrome.                KEYWORDS:Nephrotic syndrome, Steroid dependency, Predictive risk factors  

DOI

10.52573/ipmj.1970.176988

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