Low Birth Weight is Associated with More Severe Course of Steroid-Sensitive Nephrotic Syndrome in Children, Multicentric Study

Abstract

Background Several previous studies have reported a more severe course of nephrotic syndrome in children with low birth weight.

Patients Cohort of 223 children with idiopathic nephrotic syndrome.

Methods We aimed to investigate the association between course of nephrotic syndrome and low birth weight. Data from seven paediatric nephrology centres were used.

Results Children with low birth weight had 3.84 times higher odds for a more severe course of steroid-sensitive nephrotic syndrome (95% CI 1.20–17.22, P=0.041), and those with low birth weight and remission after 7 days had much higher odds for a more severe course of disease (OR 8.7). Low birth weight children had a longer time to remission (median 12 vs. 10 days, P=0.03). They had a higher need for steroid-sparing agents (OR for the same sex=3.26 [95% CI 1.17–11.62, P=0.039]), and the odds were even higher in females with low birth weight (OR 6.81). There was no evidence of an association either between low birth weight and focal segmental glomerulosclerosis or between low birth weight and steroid-resistant nephrotic syndrome.

Discussion We conducted the first multicentric study confirming the worse outcomes of children with NS and LBW and we found additional risk factors.

Conclusions Low birth weight is associated with a more severe course of steroid-sensitive nephrotic syndrome, while being female and achieving remission after 7 days are additional risk factors.

Zusammenfassung

Hintergrund Mehrere frühere Studien haben über einen schwereren Verlauf des nephrotischen Syndroms bei Kindern mit niedrigem Geburtsgewicht berichtet.

Patienten Kohorte von 223 Kindern mit idiopathischem nephrotischen Syndrom.

Methoden Das Ziel war den Zusammenhang zwischen dem Verlauf des nephrotischen Syndroms und niedrigem Geburtsgewicht zu untersuchen. Es wurden Daten aus sieben pädiatrischen Nephrologiezentren verwendet.

Ergebnisse Kinder mit niedrigem Geburtsgewicht hatten eine 3,84-mal höhere Wahrscheinlichkeit eines schwereren Verlaufs des steroidsensitiven nephrotischen Syndroms (95% KI 1,20–17,22, P=0,041), und Kinder mit niedrigem Geburtsgewicht und Remission nach 7 Tagen hatten eine viel höhere Chance für einen schwereren Krankheitsverlauf (OR 8,7). Kinder mit niedrigem Geburtsgewicht hatten eine längere Zeit bis zur Remission (Median 12 vs. 10 Tage, P=0,03). Sie hatten einen höheren Bedarf an steroidsparenden Mitteln (OR für das gleiche Geschlecht=3,26 [95% KI 1,17–11,62, P=0,039]), und die Wahrscheinlichkeit war bei Frauen mit niedrigem Geburtsgewicht sogar noch höher (OR 6,81). Es gab weder Hinweise auf einen Zusammenhang zwischen niedrigem Geburtsgewicht und fokaler segmentaler Glomerulosklerose noch zwischen niedrigem Geburtsgewicht und steroidresistentem nephrotischen Syndrom.

Diskussion Wir haben die erste multizentrische Studie durchgeführt, die die schlechteren Ergebnisse von Kindern mit NS und niedrigem Geburtsgewicht bestätigt, und wir haben zusätzliche Risikofaktoren gefunden.

Schlussfolgerungen Ein niedriges Geburtsgewicht ist mit einem schwereren Verlauf des steroidsensitiven nephrotischen Syndroms assoziiert, während das weibliche Geschlecht und das Erreichen einer Remission nach 7 Tagen zusätzliche Risikofaktoren sind.

Key words

Remission - Low birth weight - nephrotic syndrome - children - steroidsparing agent

Schlüsselwörter

Remission - niedriges Geburtsgewicht - nephrotisches Syndrom - Kinder - steroidsparende Mittel

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