Predictors of time to remission in children with steroid-sensitive nephrotic syndrome: a prospective observational study in Nepal

Nephrotic syndrome is the most prevalent glomerular disease in children and corticosteroids are the mainstay of treatment. Although most children are steroid-sensitive, the response time varies. There is very limited research determining the factors that influence time to remission following steroid therapy. This study aims to identify predictors of time to remission in children with steroid-sensitive nephrotic syndrome (SSNS) at a tertiary level hospital in Nepal. A prospective observational study was conducted from June 2022 to May 2023 following ethical approval. Fifty-four children with SSNS aged 1–14 years were enrolled and prospectively followed with daily urine albumin dipstick test at home after initiating standard-dose steroid therapy until remission was achieved. The time to remission was recorded. Patients were categorized into early and late responder groups using a 9-day cut-off post-hoc. Independent student’s t-test, Mann-Whitney U test, fisher exact test and chi-square test were used to compare clinical and laboratory variables between groups. Among 54 participants enrolled, 44 (81.5%) presented with a first episode and 10 (18.5%) with a relapse. The cohort had a male-to-female ratio of 2:1. The median age at onset was 5.0 years (IQR: 4.0, 9.0). The mean time to remission was 8.6 ± 1.7 days. Thirty-two (59.2%) participants were classified as early responders (< 9 days) and 22 (40.8%) as late responders (≥ 9 days). Remission was delayed in patients with hypertension and hematuria, although this trend was not statistically significant. None of the clinical variables (like age, gender, religion, geographical region, socioeconomic status, episode type (first episode/relapse), patient related factors like anemia, AKI, hypertension, ) and laboratory variables (like microscopic hematuria, raised serum creatinine, degree of hypoalbuminemia, hypercholesterolemia and severity of proteinuria) were significantly associated with time to remission in our analysis. This highlights the complexity of predicting steroid response and emphasizes the need for larger, multi-center studies to identify robust predictors of remission dynamics in pediatric nephrotic syndrome.