Factors Associated with Relapse in Children with Nephrotic Syndrome

Open Access

Abstract

Background: Childhood nephrotic syndrome frequently follows a relapsing course, increasing treatment burden and exposure to corticosteroids and other immunosuppressive therapies. Identifying factors associated with relapse may support closer monitoring and individualized management. Aim of the study: To determine the clinical, laboratory, disease-related, and treatment-related factors associated with relapse among children with nephrotic syndrome and identify factors associated with recurrent disease. Methods & Materials: This cross-sectional analytical study included 95 children aged 2-15 years with nephrotic syndrome. Participants were selected by purposive sampling. Sociodemographic, clinical, laboratory, treatment, adherence, and follow-up data were collected from interviews, clinical examinations, laboratory reports, treatment records, and follow-up documentation. Associations were assessed using appropriate statistical tests, followed by multivariable logistic regression. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated, with p<0.05 considered statistically significant. Result: Among 95 children, 69 (72.63%) experienced relapse, including 31 (32.63%) frequent relapsers and 38 (40.00%) infrequent relapsers. Children with relapse were younger (6.8±2.9 vs. 8.3±3.4 years, p=0.032), had a younger age at diagnosis (5.0±2.5 vs. 6.4±3.0 years, p=0.024), longer illness duration (2.1±1.4 vs. 1.1±0.9 years, p=0.001), and lower serum albumin (2.0±0.4 vs. 2.3±0.5 g/dL, p=0.006). Steroid dependence (39.13% vs. 7.69%, p=0.003), medication non-adherence (27.54% vs. 7.69%, p=0.048), delayed remission (65.22% vs. 42.31%, p=0.049), infection during follow-up (40.58% vs. 19.23%, p=0.049), and serum albumin <2.5 g/dL (85.51% vs. 61.54%, p=0.011) were associated with relapse. Multivariable analysis identified age at diagnosis <5 years (aOR 2.41, 95% CI 1.01-5.74), illness duration ≥2 years (aOR 2.87, 95% CI 1.16-7.08), steroid dependence (aOR 4.36, 95% CI 1.45-13.12), medication non-adherence (aOR 3.18, 95% CI 1.05-9.61), remission after >10 days (aOR 2.63, 95% CI 1.08-6.42), serum albumin <2.5 g/dL (aOR 2.74, 95% CI 1.08-6.94), and infection during follow-up (aOR 2.52, 95% CI 1.02-6.22) as independent factors associated with relapse. Conclusion: Relapse was frequent among children with nephrotic syndrome and was independently associated with younger age at diagnosis, prolonged illness, steroid dependence, medication non-adherence, delayed remission, hypoalbuminemia, and infection during follow-up. Recognition of these factors may facilitate risk stratification and closer clinical surveillance. Strengthening adherence, preventing and promptly treating infections, and individualized follow-up of children with delayed remission or steroid dependence may help reduce recurrent episodes and cumulative treatment burden.