İdiyopatik Nefrotik Sendromda İlk Atakta Steroid Bağımlılığı Öngörülebilir mi?

Objective: Idiopathic nephrotic syndrome (INS) is the most common glomerular disease in children. Approximately 80% of INS is steroid sensitive (SSNS), and half of SSNS patients are steroid dependent (SDNS). This study determines the risk factors that may predict steroid dependence in patients with SSNS. Material and Method: Patients with SSNS who followed in our Pediatric Nephrology clinic between September 2016 and September 2018 were retrospectively evaluated. The demographic characteristics, albumin, creatinine values, blood pressure, white blood cell, lymphocyte count, lymphocyte/white blood cell ratio, urine protein–creatinine ratio, time to remission, and triggers of the attack were recorded. Results: Twenty-three patients were diagnosed as SSNS and 16 as SDNS. The mean age at presentation was 77.34±32 months in the SSNS group and 73.62±27.32 months in the SDNS group (p=0.690). No significant difference was observed between the two groups in terms of blood albumin, creatinine, lymphocyte count, and lymphocyte/white blood cell ratio. Trigger initiating the attack was more common in the SDNS group (p=0.001). The most common trigger was upper respiratory tract infection. Urine protein/creatinine ratio and white blood cell levels were significantly higher in the SDNS group (p=0.014, p=0.004, respectively), and the time to remission was also longer in the SDNS group (p=0.001). Conclusion: Upper respiratory tract infection may be a trigger, and severe proteinuria and late remission time may be risk factors for the development of SDNS in INS. Early use of steroid-sparing agents in these patients can prevent long-term adverse effects of steroid therapy.