The Triggers and Patterns of Relapse in Childhood Idiopathic Nephrotic Syndrome: A Retrospective, Descriptive Study in a Tertiary Hospital, South-East Nigeria

Nephrotic syndrome (NS) refers to the constellation of massive proteinuria, hypoalbuminemia, generalized oedema and hyper lipidemia due to failure of the glomerular filtration barrier [1]. The syndrome in children is commonly caused by either of two idiopathic diseases: minimal-changenephropathy (MCN) and focal segmental glomerulosclerosis (FSGS) [1]. According to a report by the International Study of Kidney Disease in Children (ISKDC), a vast majority of pre-adolescent children with idiopathic NS present with MCN on renal biopsy [2]. This histological subtype had previously been documented as the most common cause of childhood nephrotic syndrome [3]; more than 90% of affected children achieve remission with oral corticosteroids and are identified as having steroid-sensitive NS (SSNS) [4,5]. The disease progresses to frequent relapses, often accompanied by steroid dependence in about 20% to 60% of patients [6]. The majority of children with FSGS have steroidresistance, as only 20% respond to corticosteroids with a high risk of developing end-stage renal disease [7]. Thus, the main treatment challenges in idiopathic NS are steroid resistance, frequent relapses and steroid dependence [8]. Abstract