STUDY ON RISK FACTORS FOR RELAPSE IN CHILDHOOD NEPHROTIC SYNDROME IN A TERTIARY CARE CENTRE OF EASTERN INDIA

Abstract

Background: Nephrotic syndrome is a common renal disease in children characterised by massive proteinuria,hypoalbuminemia(serum albumin <2.5g/dl),hyperlipidemia(serum cholesterol>200mg/dl) and edema.It has high propensity for relapse.Approximately 80-90%of steroid sensitive nephrotic syndrome patients experience one or more relapses during their lifetime. So,the main problem in such disease is relapses and their association with complications of disease or side effects of drugs like steroid used in treatment.An understanding of risk factors that determine the course,is useful in taking decisions regarding therapy and counselling of parents.Ascarcity of reported data on risk factors for relapse from eastern India prompted to carry out this study in a tertiary care hospital. Aims And Objectives:To determine different risk factors for relapse in childhood nephrotic syndrome. Materials And Method: A retrospective analysis of medical records of children with steroid sensitive nephrotic syndrome of 1-12 years of age,with history of disease onset atleast 1 year back,attending inpatient and outpatient department of Pediatric medicine,IPGME&R,Kolkata was carried out from February 2016 –July 2017 after obtaining ethical clearance from Instituitional Ethics committee and written informed consent from parents. Results: Records of 60 children with SSNS were reviewed.The mean age of the study population was7.3±2.7 years. Boys constituted 63.3% & girls constituted 36.7% of total study population. 23 patients were included in FRNS/SDNS group,rest 37 patients were in IFRNS/No relapse group.Data were analyzed by using SPSS 20.0.1 programme and Graph Pad Prism version 5. Chi-square test & Two-sample t-tests were used as statistical test & p value <0.05 was taken as signicant.Compared to IFRNS/No relapse,patients with FRNS/SDNS had signicantly more infections during 1st episode,more association with massive edema, more number of patients with inadequate duration of treatment (<8weeks or irregular) and longer achievement of remission(14.3±2.7 days vs10±2.1),shorter steroid free time interval between completion of treatment of 1st attack & onset of 1st relapse.FRNS group had signicantly less serum albumin(1.68±0.202 vs 2.05±0.17g/dl) during disease onset than IFRNS/No relapse group. Conclusion: Presence of infection & massive edema during disease onset, inadequate initial treatment,prolonged achievement of remission,low serum albumin during disease onset ,short steroid free time interval between completion of treatment of 1st attack &onset of 1st relapse were observed as statistically signicant risk factors for frequently relapse.These observations need to be validated by multicenter prospective study with larger sample size.