Prediction of early response to steroids in nephrotic syndrome patients aged between 2 and 10 years

Abstract

Objective: The primary objective was to predict onset of remission within 10 days of starting corticosteroid treatment in nephrotic syndrome patients aged between 2 and 10 years (either first episode or first relapse) using clinical and laboratory variables. The secondary objective was to compare changes in CD4 count and percentage among newly diagnosed cases. Method: Prospective cohort study with a nested case–control design was conducted from September 2009 to August 2010 after institutional ethical clearance. Included were cases aged 2–10 years diagnosed as nephrotic syndrome based on standard clinical and laboratory criteria. Controls were age- and sex-matched healthy subjects recruited from the outpatient's department. Results: Included were 44 cases (26 newly diagnosed and 16 were first relapse) cases of nephrotic syndrome and 38 healthy age- and sex-matched controls. Variables in the linear regression model predicting remission were sex, presence of tuberculosis, Low-Density Lipoprotein (LDL)/High Density Lipoprotein (HDL) ratio and antihypertensive medication, serum LDL, serum triglyceride, and serum creatinine. CD4 count, CD4%, and CD4% rise were significantly high in first episode of nephrotic syndrome as compared to controls. Serum Very Low Density Lipoprotein (VLDL) was raised in late responders of first episode of nephrotic syndrome. Conclusion: Female gender, concomitant tuberculosis, and raised serum VLDL delayed onset of remission while use of angiotensin converting enzyme inhibitors in hypertensive patients decreased the duration of proteinuria in cases of nephrotic syndrome in children.