Patterns, triggers, and predictors of relapses among children with steroid-sensitive idiopathic nephrotic syndrome at the University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Abstract

Background Childhood steroid-sensitive idiopathic nephrotic syndrome (SSINS) is plagued with relapses that contribute to its morbidity and the cost of treatment. Patients and methods This is a retrospective review of relapses among children with SSINS at the University of Abuja Teaching Hospital from January 2016 to July 2020. Triggers related to relapse incidents were noted. χ2 test was deployed for predictors (factors at the first clinical presentations that associate with subsequent relapses) of relapses. Predictors with P values of less than 0.05 were considered significant, and 95% confidence intervals (CI) and odd ratio (OR) were described. Results A total of 60 patients with SSINS, comprising 52 (86.7%) males, aged 23 months to 18 years, with a mean age of 7.04±4.16 years, were studied. A total of 38 (63.3%) participants had 126 relapses, including infrequent relapses in 30 (78.9%) and frequent relapses in eight (21.1%). The commonest triggers were acute upper respiratory tract infections (68, 53.9%) and urinary tract infections in 25 (19.8%) relapses. In four (3.2%) relapses, no trigger was identified. The time-to-first relapse ranged 14–365 days, with a median time of 60 days. The significant predictors were hypertension (OR=3.4, 95% CI; 1.04–11.09, P=0.038), urinary tract infections (OR=9.9, 95% CI; 1.16–80.71, P=0.014), malaria fever (OR=8.0, 95% CI; 2.45–26.38, P<0.001), microhematuria (OR=4.9, 95% CI; 11.58–15.16, P=0.004), elevated serum creatinine (OR=12.3, 95% CI; 1.48–101.20, P=0.005), and hypercholesterolemia (OR=4.1, 95% CI; 1.35–12.63, P=0.011). Conclusion Although the pathogenesis of relapses remains unknown, it is prudent to consider relapse-specific preventive strategies against triggers and predictors of relapses in our setting.