Childhood Nephrotic Syndrome, Frequent and Infrequent Relapses and Risk Factors for Relapses
Iraqi Postgraduate Medical Journal,
2009, Volume 8, Issue 3, Pages 291-295
Most patients with steroid sensitive nephrotic syndrome (SSNS) have frequent relapses until disease resolve spontaneously toward the end of second decade of life and so the main problem in such disease is frequent relapses and their association with complications of disease or side effects of drugs used in each relapse.
In this study, we evaluate different factors which might be associating or leading to occurrence of frequent relapses.
PATIENTS AND METHODS:
A retrospective study was done in the Central Child Teaching Hospital from Feb. 2007 - Feb. 2008, during this period, 120 patients with nephrotic syndrome (NS) randomly selected who were diagnosed & or treated in this hospital. Out of 120 patients, 85 (70.8%) patients with steroid sensitive nephrotic syndrome (SSNS), 9 (7.5%) patients with steroid dependant nephrotic syndrome (SDNS) and 26 (21.7%) patients with steroid resistant nephrotic syndrome (SRNS). The steroid sensitive patients were divided into 24 (28.2%) patients as undetermined (UD) group, 35 (41.2%) patients with frequent relapses (FR) group and 26 (30.5%) patients with infrequent relapses (IFR) group. We compare between frequent and infrequent groups regarding to age, sex, type of presentation, biochemical finding, precipitating factors, family history of renal disease, the time needed to responsd to steroid therapy and duration of steroid therapy.
The age ranged from 1-16 years, with peak incidence at age group from 1-5 years. There were 64 patients (53.3%) presented with this age group, most of them were steroid sensitive nephrotic syndrome 53 (82.5%) patients. There were 73 male and 47 female & M: F ratio 1.5: 1, most of them (70.8%) with steroid sensitive nephrotic syndrome & male to female ratio was 1.8: 1. The main type of presentation was preiorbital oedema; the main type of precipitating factor was respiratory tract infection. The family history of renal disease (P value = 0.0006) and the delay in response to steroid therapy, 2 weeks and more (P value = 0.0477 & 0.0486) were statistically significant correlation with frequent relapsers (FR) group in comparison to infrequent (IFR) group.
There were no statistically significant differences between frequent and infrequent groups regarding other factors.
There were significant correlation between family history of renal disease & delay in response to steroid therapy with occurrence of frequent relapses supporting other studies but this study fails to confirm previous studies about other factors
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