Prognostic factors and survivals of children with steroid-resistant nephrotic syndrome

Background Children with steroid resistant nephrotic syndrome (SRNS) generally survive, although during the course of disease their kidney function may decrease, leading to end-stage renal disease (ESRD). There have been few studies reporting on the survivals of children with SRNS. Objectives To determine patient and kidney survival rates in children with SRNS at the first, second, third, fourth, and fifth years; and to evaluate the effects of age at onset, initial kidney function, hypertension, and type of resistance, on the survivals of children with SRNS. Methods This retrospective cohort study was performed using secondary data obtained from medical records of patients with SRNS in Department of Child Health, Cipto Mangunkusumo Hospital, between 2004-2011. The outcomes of kidney survivals were defined in two ways: lack of doubling of base creatinine levels and lack of ESRD. Results There were 45 children with SRNS in our study, Their median duration of illness was 24 (range 12-95) months. Twenty percent of the subjects died, 31.1% had a doubling of base creatinine levels, and 13.4% developed ESRD. Life survival rates of subjects at the first, second, third, fourth, and fifth years after diagnosis were 930, 84%, 80%, 72%,and 61%, respectively. Kidney survival rates determined by the lack of doubling of base creatinine levels at the first, second, third, fourth and fifth years were 92%, 72%, 56%, 42%, and 34%, respectively, while kidney survival rates determined by the lack of ESRD were 97%, 88%, 81%, 70%, and 58%, respectively. Age at onset, initial kidney function, hypertension at onset, and type of resistance, did not significantly affect the survivals of children with SRNS. Conclusion Children with SRNS are prone to develop a doubling of base creatinine levels and ESRD. Factors such as age, initial kidney function, hypertension at onset, and type of resistance, do not significantly affect both, life and kidney survivals of children with SRNS.