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Prediction of Short- and Long-Term Outcomes in Childhood Nephrotic Syndrome

INTRODUCTION: It is unknown whether steroid sensitivity and other putative risk factors collected at baseline can predict the disease course of idiopathic nephrotic syndrome in childhood. We determined whether demographic, clinical, and family reported factors at presentation can predict outcomes in...

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Autores principales: Carter, Simon A., Mistry, Shilan, Fitzpatrick, Jessica, Banh, Tonny, Hebert, Diane, Langlois, Valerie, Pearl, Rachel J., Chanchlani, Rahul, Licht, Christoph P.B., Radhakrishnan, Seetha, Brooke, Josefina, Reddon, Michele, Levin, Leo, Aitken-Menezes, Kimberly, Noone, Damien, Parekh, Rulan S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136435/
https://www.ncbi.nlm.nih.gov/pubmed/32280840
http://dx.doi.org/10.1016/j.ekir.2019.12.015
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author Carter, Simon A.
Mistry, Shilan
Fitzpatrick, Jessica
Banh, Tonny
Hebert, Diane
Langlois, Valerie
Pearl, Rachel J.
Chanchlani, Rahul
Licht, Christoph P.B.
Radhakrishnan, Seetha
Brooke, Josefina
Reddon, Michele
Levin, Leo
Aitken-Menezes, Kimberly
Noone, Damien
Parekh, Rulan S.
author_facet Carter, Simon A.
Mistry, Shilan
Fitzpatrick, Jessica
Banh, Tonny
Hebert, Diane
Langlois, Valerie
Pearl, Rachel J.
Chanchlani, Rahul
Licht, Christoph P.B.
Radhakrishnan, Seetha
Brooke, Josefina
Reddon, Michele
Levin, Leo
Aitken-Menezes, Kimberly
Noone, Damien
Parekh, Rulan S.
author_sort Carter, Simon A.
collection PubMed
description INTRODUCTION: It is unknown whether steroid sensitivity and other putative risk factors collected at baseline can predict the disease course of idiopathic nephrotic syndrome in childhood. We determined whether demographic, clinical, and family reported factors at presentation can predict outcomes in idiopathic nephrotic syndrome. METHODS: An observational cohort of 631 children aged 1 to 18 years diagnosed with idiopathic nephrotic syndrome between 1993 and 2016 were followed up until clinic discharge, 18 years of age, end-stage kidney disease (ESKD), or the last clinic visit. Baseline characteristics were age, sex, ethnicity, and initial steroid sensitivity. Of these, 287 (38%) children also reported any family history of kidney disease, preceding infection, microscopic hematuria, and history of asthma/allergies. The outcomes were complete remission after initial steroid course, need for a second-line agent, frequently relapsing disease, and long-term remission. The discriminatory power of the models was described using the c-statistic. RESULTS: Overall, 25.7% of children had no further disease after their initial steroid course. In addition, 31.2% developed frequently relapsing disease; however, 77.7% were disease-free at 18 years of age. Furthermore, 1% of children progressed to ESKD. Logistic regression modeling using the different baseline exposures did not significantly improve the prediction of outcomes relative to the observed frequencies (maximum c-statistic, 0.63; 95% confidence interval [CI], 0.59–0.67). The addition of steroid sensitivity did not improve outcome prediction of long-term outcomes (c-statistic, 0.63; 95% CI, 0.54–0.70). CONCLUSIONS: Demographic, clinical, and family reported characteristics, specifically steroid sensitivity, are not useful in predicting relapse rates or long-term remission in idiopathic nephrotic syndrome. Further studies are needed to address factors that contribute to long-term health.
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spelling pubmed-71364352020-04-10 Prediction of Short- and Long-Term Outcomes in Childhood Nephrotic Syndrome Carter, Simon A. Mistry, Shilan Fitzpatrick, Jessica Banh, Tonny Hebert, Diane Langlois, Valerie Pearl, Rachel J. Chanchlani, Rahul Licht, Christoph P.B. Radhakrishnan, Seetha Brooke, Josefina Reddon, Michele Levin, Leo Aitken-Menezes, Kimberly Noone, Damien Parekh, Rulan S. Kidney Int Rep Clinical Research INTRODUCTION: It is unknown whether steroid sensitivity and other putative risk factors collected at baseline can predict the disease course of idiopathic nephrotic syndrome in childhood. We determined whether demographic, clinical, and family reported factors at presentation can predict outcomes in idiopathic nephrotic syndrome. METHODS: An observational cohort of 631 children aged 1 to 18 years diagnosed with idiopathic nephrotic syndrome between 1993 and 2016 were followed up until clinic discharge, 18 years of age, end-stage kidney disease (ESKD), or the last clinic visit. Baseline characteristics were age, sex, ethnicity, and initial steroid sensitivity. Of these, 287 (38%) children also reported any family history of kidney disease, preceding infection, microscopic hematuria, and history of asthma/allergies. The outcomes were complete remission after initial steroid course, need for a second-line agent, frequently relapsing disease, and long-term remission. The discriminatory power of the models was described using the c-statistic. RESULTS: Overall, 25.7% of children had no further disease after their initial steroid course. In addition, 31.2% developed frequently relapsing disease; however, 77.7% were disease-free at 18 years of age. Furthermore, 1% of children progressed to ESKD. Logistic regression modeling using the different baseline exposures did not significantly improve the prediction of outcomes relative to the observed frequencies (maximum c-statistic, 0.63; 95% confidence interval [CI], 0.59–0.67). The addition of steroid sensitivity did not improve outcome prediction of long-term outcomes (c-statistic, 0.63; 95% CI, 0.54–0.70). CONCLUSIONS: Demographic, clinical, and family reported characteristics, specifically steroid sensitivity, are not useful in predicting relapse rates or long-term remission in idiopathic nephrotic syndrome. Further studies are needed to address factors that contribute to long-term health. Elsevier 2019-12-27 /pmc/articles/PMC7136435/ /pubmed/32280840 http://dx.doi.org/10.1016/j.ekir.2019.12.015 Text en © 2020 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical Research
Carter, Simon A.
Mistry, Shilan
Fitzpatrick, Jessica
Banh, Tonny
Hebert, Diane
Langlois, Valerie
Pearl, Rachel J.
Chanchlani, Rahul
Licht, Christoph P.B.
Radhakrishnan, Seetha
Brooke, Josefina
Reddon, Michele
Levin, Leo
Aitken-Menezes, Kimberly
Noone, Damien
Parekh, Rulan S.
Prediction of Short- and Long-Term Outcomes in Childhood Nephrotic Syndrome
title Prediction of Short- and Long-Term Outcomes in Childhood Nephrotic Syndrome
title_full Prediction of Short- and Long-Term Outcomes in Childhood Nephrotic Syndrome
title_fullStr Prediction of Short- and Long-Term Outcomes in Childhood Nephrotic Syndrome
title_full_unstemmed Prediction of Short- and Long-Term Outcomes in Childhood Nephrotic Syndrome
title_short Prediction of Short- and Long-Term Outcomes in Childhood Nephrotic Syndrome
title_sort prediction of short- and long-term outcomes in childhood nephrotic syndrome
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136435/
https://www.ncbi.nlm.nih.gov/pubmed/32280840
http://dx.doi.org/10.1016/j.ekir.2019.12.015
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