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Multicenter Study
. 2025 Mar 20;184(4):262.
doi: 10.1007/s00431-025-06090-z.

Time to remission in childhood steroid sensitive nephrotic syndrome: a change in perspective

Beatrice Nardini  1 , Claudio La Scola  2 , Ciro Corrado  3 , Alberto Edefonti  4 , Mario Giordano  5 , Roberto Pillon  2 , Antonio P Mastrangelo  4 , Marco Materassi  6 , Irene Alberici  2 , William Morello  4 , Giuseppe Puccio  7 , Giovanni Montini  4   8 , Andrea Pasini  2
Affiliations
Multicenter Study

Time to remission in childhood steroid sensitive nephrotic syndrome: a change in perspective

Beatrice Nardini et al. Eur J Pediatr. .

Abstract

Time to remission (TTR) has been largely considered one of the predictive factors for the risk of relapse and steroid dependency in childhood steroid-sensitive nephrotic syndrome, yet conflicting opinions exist. However, the factors influencing TTR have never been studied. We performed a post-hoc analysis of the prospective pediatric cohort enrolled in a previous multicenter study (ClinicalTrials.gov Id: NCT01386957) to evaluate the possible influence of some clinical and laboratory parameters at INS onset on the timing of TTR. A total of 136 children were evaluated. In simple linear regression models, TTR was directly correlated with serum uric acid, urea, potassium, and urinary protein levels at onset. TTR showed a non-linear inverse correlation with age at onset. A multiple linear regression model of TTR showed that hyperuricemia (p = 0.0000007), non linear age (p = 0.0006) and proteinuria (especially in binary form) (p = 0.02) were significant predictors of TTR, and that there was a significant positive interaction between uricemia and proteinuria as predictors of TTR (p = 0.004). Conclusions: In our analysis, TTR appears to be associated to a nephrotic status at clinical diagnosis characterized by more severe proteinuria and hyperuricemia. Moreover, younger age at onset, notably associated with prognosis, is also associated with a longer TTR. What is Known: • Corticosteroids are the first-line treatment in childhood nephrotic syndrome. • Over the years, time to remission has been considered a potential predictive factor for the risk of relapse and steroid dependency in childhood nephrotic syndrome, with conflicting results. What is New: • Clinical and laboratory parameters at nephrotic syndrome onset are associated with prolonged time to remission in children.

Keywords: Childhood nephrotic syndrome; Hypovolemia; Steroid therapy; Time to remission.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Correlation between age at onset and TTR (a) using TTR as a linear variable (b) using TTR as a categorical variable
Fig. 2
Fig. 2
Effect plot of predictors for TTR in multiple regression model: a non linear age (natural splines) (b) interaction between uricemia and binary proteinuria
See this image and copyright information in PMC

References

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