ESPN 51th Annual Meeting

ESPN 2018


 
Nephrotic syndrome in child: risk factors for steroid dependency
FERJANI MARYEM 1 HAMMI YOUSRA 1 BOUSETTA ABIR 1 JAOUADI MERYEM 1 JELLOULI MANEL 1 GARGAH TAHAR 1

1- DEPARTMENT OF PEDIATRIC NEPHROLOGY OF CHARLES NICOLLE, TUNIS,TUNISIA
 
Introduction:

 

Most patients with idiopathic nephrotic syndrome are steroid-responsive, about 50% become steroid-dependent .The aim of this study was to determine predictive risk factors for steroid dependence .

Material and methods:

 

Retrospective hospital-based cohort study in the department of pediatric nephrology of Charles Nicolle, Tunis during 10 years included 52 children with idiopathic steroid-responsive nephrotic syndrome, hospitalized for the first manifestation of the nephotic syndrome in the department and followed for at least one year.

Results:

 

A total of 52 children with first presentation of idiopathic nephrotic syndrome with a median age of 5.1 years were studied. Male to female ratio was 2.71. The median blood level of albumin was 11.7 g/l, of alpha2globulin was 17.1g/l, of cholesterol was 10.7 mmol/l and the median proteinuria was 148 mg/kg/day.The median time for first remission was 15.8 days. Thirty-eight patients (73%) relapsed and 31 patients (59.6%) became steroid dependent. Risk factors for steroid dependency identified from univarite analysis were season of the first episode (winter or autumn) (p=0.008), hyperalpha2globulinemia>16g/l (p=0.028), hyperbeta2globulinemia  >3g/l (p=0.003), hypercholesterolemia>10mmol/l (p=0.001), proteinuria>110mg/kg/day (p=0.05), time to achieve remission<9 days (p=0,0001), early first relapse (p=0.0038) and respiratory tract infection triggered first relapse (p=0.012).

Logistic regression revealed that time to first remission, hypercholesterolemia>10mmol/l at first presentation and a respiratory tract infection at first relapse are independent risk factors for steroid dependency.

Conclusions:

 

Delay to first remission, hypercholesterolemia more than 10mmol/l at first presentation and a respiratory tract infection at fisrt relapse are independent risk factors for steroid dependency.