Prediction of subsequent relapse in children with steroid-sensitive nephrotic syndrome

Among nephrotic children with frequent relapses at risk for cumulative ster oid toxicity, identification of children who may be at high risk for subseq uent relapse is very important in making the decision to introduce cytotoxi c drugs. We examined the clinical course of 467 relapses in 121 steroid-sen sitive nephrotic children to elucidate the risk factors for subsequent rela pse, using the Cox proportional-hazards regression model. Gender, age at on set, duration of illness from onset, prednisolone dosage at the most-recent relapse, and regimens of initial steroid therapy at onset were not associa ted with risk. Relapse with-in the 1st year was a powerful independent pred ictor of subsequent relapse irrespective of the duration of illness. The ha zard ratio of patients with more than one relapse within the Ist year incre ased to 1.72-2.12 compared with those without a relapse within the 1st year . The remission period just before the most-recent relapse was also a signi ficant predictor. The risk for patients with a 1-year or longer remission p eriod decreased to 0.57. Patients treated with cyclophosphamide for 12 week s had a significantly longer remission than those treated with prednisolone alone. Our results sugclest that early relapse after onset and/or a short remission period just before recent relapse are independent risk factors fo r subsequent relapse. Cytotoxic therapy has serious adverse effects and its effect may be limited. Our results may be helpful in deciding on the suita bility of cytotoxic drugs.