Abstract
Background: Development of steroid dependency is one of the difficult problems in the
management of children with idiopathic nephrotic syndrome, leading to increased
morbidity, complications and cost of treatment. Thus, predicting early in the disease
course will be useful in counseling parents and may improve treatment strategy.
Objectives: To determine the clinical characteristics that can predict the development of
steroid dependency early in the initial episodes of steroid sensitive nephrotic syndrome
(SSNS).
Patients and Methods: The study included 52 children with SSNS. Their ages ranged from
3 to 16 years. Patients were divided into two groups. Group A consisted of 24 patients
with steroid dependency or frequent relapses nephrotic syndrome and group B consisted
of 28 patients with complete remission or recurrent nephrotic syndrome. Data obtained
retrospectively from patients’ files.
Results: Children who require a cumulative steroid dose equal or more than 140 mg/kg
to maintain remission during the first 6 months of the disease are at high risk to require
steroid sparing agents (SSA) for disease control, and who did not achieve remission by
day 20 of the initial prednisone course became steroid dependent with 96% specificity but
with low sensitivity (50%). All steroid dependent children in this study showed relapses
associated significantly with upper respiratory tract infections.
Conclusions: Cumulative steroid dose in the first 6 months of treatment and the need of
more than 20 days to achieve initial remission can predict steroid dependency in children
with nephrotic syndrome.