Disease course in steroid sensitive nephrotic syndrome.

OBJECTIVE

To review the disease course in patients with steroid sensitive nephrotic syndrome (SSNS) and the factors that determine outcome

DESIGN

Retrospective, analytical

SETTING

Pediatric Nephrology Clinic at referral center in North India

PARTICIPANTS/PATIENTS: All patients with SSNS evaluated between 1990 and 2005 INTERVENTION: None

MAIN OUTCOME MEASURES

Disease course, in patients with at least 1-yr follow up, was categorized as none or infrequent relapses (IFR), frequent relapses or steroid dependence (FR), and late resistance. Details on complications and therapy with alternative agents were recorded.

RESULTS

Records of 2603 patients (74.8% boys) were reviewed. The mean age at onset of illness and at evaluation was 49.7±34.6 and 67.5±37.9 months respectively. The disease course at 1-yr (n=1071) was categorized as IFR in 37.4%, FR in 56.8% and late resistance in 5.9%. During follow up, 224 patients had 249 episodes of serious infections. Alternative medications for frequent relapses (n=501; 46.8%) were chiefly cyclophosphamide and levamisole. Compared to IFR, patients with FR were younger (54.9±36.0 vs. 43.3±31.4 months), fewer had received adequate (=8 weeks) initial treatment (86.8% vs. 81.7%) and had shorter initial remission (7.5±8.6 vs. 3.1±4.8 months) (all P<0.001). At follow up of 56.0±42.6 months, 77.3% patients were in remission or had IFR, and 17.3% had FR.

CONCLUSIONS

A high proportion of patients with SSNS show frequent relapses, risk factors for which were an early age at onset, inadequate initial therapy and an early relapse.