The evaluation of the effect of the length of Induction course of the childhood idiopathic nephrotic syndrome on relapse risk

Idiopathic nephrotic syndrome (INS) is characterized by relapsing proteinuria with potentially risk of the adverse effect of corticosteroid therapy. Although considerable evidence suggests an overall reduction of the relative risk of relapse with longer duration of daily steroid therapy, there is no definite clue to find out which patient needs this elongation.Initial daily steroid therapy can be divided into two parts by determination of remission point; as induction phase, since start to remission point, and consolidation phase, from remission till end of daily steroid therapy. The propose of this study is to compare the relapse rate among the patients with constant 3 weeks consolidation course despite different remission point at initial steroid therapy.Method and materials: All new cases of childhood INS selected. Oral prednisolone at 2mg/kg/d(max.60mg), as single morning dose was started. Parents asked to examine daily morning spot urine with dip stick to find out remission point and treatment was continued for next 3 weeks as consolidation course. Further maintenance therapy was done based on ISKDC recommendation. Patients with induction phase less than 3 days or more than 21 days were excluded. Patients categorized into 3 groups; G1: induction phase ≤1week (9 patients), G2: > 1week≤2 weeks (8 patients) G3: > 2weeks≤3 weeks (8 patients) and followed 2 years for relapse rate. Patients Results: Twenty-five out of 69 INS patients enrolled study. Two years relapse rate in G1, G2 and G3 were found 3/9(33%), 3/8(37%) and 5/8(62.5%), respectively. Average relapse episode/2 years were 7/9(0.78) in G1, 7/8(0.87) in G2 and 11/8(1.38) in G3. Mean time to first relapse (interval time) in each group was 106.7days, 86days and 67days, respectively. There were no significant differences between groups regarding relapse rate, relapse episodes and interval time. (ρ.value=0.43, =0.71&=0.73, respectively).Conclusion: consolidation course has important predictive value for relapse risk, thereby directly impacting decision-making and treatment plan in INS. More studies with greater sample size suggested.

کلیدواژه ها:

nephrotic syndrome ، induction ، relapse ، children