FACTORS ASSOCIATED WITH RELAPSE IN NEPHROTIC SYNDROME

Abstract

Objective: To determine the factors associated with relapse in nephrotic syndrome (NS) in children.

Methods: A cross-sectional study was conducted in the Department of Pediatric Medicine at Central Park Teaching Hospital Lahore from 1 August to 31 January 2025, using non-probability consecutive sampling. The study included children aged 2 to 10 years, diagnosed with nephrotic syndrome and presenting with relapse, of either gender. Exclusion criteria were children lost to follow-up or with steroid-resistant nephrotic syndrome, as they could introduce bias. After ethical approval, all eligible children from the Department of Pediatric Medicine, Central Park Teaching Hospital Lahore, were enrolled. Detailed history and physical exams, including weight, height, and abdominal tenderness, were recorded. Investigations included hemoglobin, leukocyte count, ESR, chest X-ray, urine tests for protein and red blood cells, 24-hour urinary protein, and protein-to- creatinine ratio. Blood pressure was measured, and nutritional assessments like MUAC and weight-for-height Z-scores were performed. Data were recorded in a pre-designed proforma, ensuring exclusion criteria were followed to minimize bias. 

Results: A total of 142 children with nephrotic syndrome who presented with relapse were enrolled, including 85 males (60%) and 57 females (40%). The mean age was 5.99 ± 2.47 years, with a mean weight of 20.88 ± 6.47 kg and a mean height of 104.51 ± 12.11 cm. Most participants (81%) were from rural areas. Hypertension affected 92 children (64.8%), and malnutrition was present in 81 children (57%). Infections were observed in 29 children (20.4%), and hematuria was seen in 11 children (7.7%). Gender distribution across these factors was analyzed. Hypertension was more common in males (p = 0.034), while females were more likely to experience hematuria (p = 0.022). There was no significant gender difference in malnutrition (p = 0.607), but moderate malnutrition was more prevalent in males, while severe malnutrition was more common in females (p = 0.006). Parental education levels varied, with most parents having matriculation education, and socioeconomic status was evenly distributed among upper, middle, and lower classes. The relationship  between gender and place of residence (p = 0.216), infection (p = 0.564), and parental education (p = 0.635) showed no statistical significance, suggesting that these factors did not differ substantially between males and females.

Conclusion: This study highlights factors associated with relapse in nephrotic   syndrome in children. Significant associations were found between hypertension, malnutrition, and hematuria with gender, emphasizing the need for gender-specific management strategies. Our findings suggest targeted interventions, particularly nutritional support for females and hypertension management for males. While infections and parental education showed no significant associations, the study contributes to understanding nephrotic syndrome and calls for further research into relapse factors.