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J Nephropathol. 2017;6(3): 180-186.
doi: 10.15171/jnp.2017.31
PMID: 28975099
PMCID: PMC5607981
Scopus ID: 85019885937
  Abstract View: 4012
  PDF Download: 2088

Original Article

Predictive risk factors of steroid dependent nephrotic syndrome in children

Maher Ahmed Abdel-Hafez*, Nagy Mohamed Abou-El-Hana, Adel Ali Erfan, Mohamed El-Gamasy, Hend Abdel-Nabi

1 Pediatric Department, Faculty of Medicine, Tanta University, Egypt
*Corresponding Author: *Corresponding author: Maher Ahmed Abdel-Hafez, , Email: Maher_ahmed_2005@yahoo.com

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.


Implication for health policy/practice/research/medical education:

The results of this article can help health managers to improve protocols of managements of idiopathic nephrotic syndrome
in children by prediction of steroid dependency early in the disease course and can help in parents counsellings as well.

Please cite this paper as: Abdel-Hafe MA, Abou-El-Hana NM, Erfan AA, El-Gamasy M, Abdel-Nabi H. Predictive risk factors of
steroid dependent nephrotic syndrome in children. J Nephropathol. 2017;6(3):180-186. DOI: 10.15171/jnp.2017.31.


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Submitted: 11 Nov 2016
Accepted: 20 Jan 2017
ePublished: 02 Feb 2017
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