Luglio Agosto 2024 - Brief Report

Risk Factors for Idiopathic Nephrotic Syndrome Relapse in Pediatric Age

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Luca Pecoraro

DOI: 10.69097/41-04-2024-04

Luca Pecoraro1, Germana Longo2, Mattia Parolin2, Enrico Vidal2, Nadia Antonucci3, Valeria Silecchia2, Maria Sangermano2, Elisa Benetti2

1 Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
2 Pediatric Nephrology, Department of Women's and Children's Health, Padua University Hospital, 35122 Padua, Italy
3 Indipendent Statistician

Corresponding Author:
Luca Pecoraro
Pediatric Clinic, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy.
E-mail address: luca.pecoraro@aovr.veneto.it

 

Abstract

Introduction. Eighty percent of children with primitive nephrotic syndrome (NS) will have at least one relapse in their life. Specific risk factors could be associated with a higher incidence of relapses and a worse prognosis. This study aims to deepen the demographic and onset-related risk factors in children with known diagnosis of primitive NS attending the Pediatric Nephrology Unit of the University Hospital of Padua.
Methods. Observational, descriptive study of all children (1-11 years old) with a known diagnosis of Primitive NS who attended our Pediatric Nephrology Unit between 1 January 2002 and 31 March 2023.
Results. 49 patients were involved. 79.5% had at least one episode of NS relapse during their lifetime. 69.4% were classified as frequently relapsing or steroid-dependent NS. The relapse risk factor “non-Western ethnicity” was related to a worse prognosis and steroid-dependent NS classification (p = 0.041). The onset-related risk factor “thrombocytosis” appears to be related to a better prognosis (p = 0.03).
Conclusion. The relapse risk factors “non-Western ethnicity” and “thrombocytosis” are characterized by worse and better prognosis, respectively. This evidence could support the follow-up of primitive NS in pediatric age.

Keywords: nephrotic syndrome relapse, risk factors, ethnicity, thrombocytosis

Introduction

Eighty percent of children with primitive nephrotic syndrome (NS) will have at least one relapse in their life. Among these, fifty percent will be affected by frequently relapsing or steroid-dependent NS [1]. It is very difficult to predict NS relapses. At the same time, it is historically known that fifty percent of treated patients are affected by relapses in the first 6 months [2]. Moreover, it is demonstrated that more relapses are associated with a worse prognosis [1]. Several studies demonstrated that specific risk factors for NS relapses could be associated with a higher incidence of NS relapses. On the one hand, demographic risk factors, such as male sex, atopy, rural background, low socioeconomic status, and non-Western ethnicity, are involved. On the other hand, onset NS-related risk factors are associated with more relapses, such as age < 5 years, reduced serum albumin and serum total protein, reduced nutritional status, remission no sooner than two weeks of steroid therapy, concurrent infectious episode, poor compliance in steroid therapy [4, 8]. This study aims to deepen the demographic and onset-related risk factors for NS relapse in children with known diagnosis of primitive NS attending the Pediatric Nephrology Unit of the University Hospital of Padua. 

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