Triggers of relapse in steroid-dependent and frequently relapsing nephrotic syndrome (original) (raw)

Abstract

An awareness of the triggers of relapse is critical for the control of steroid-dependent, frequently relapsing nephrotic syndrome (SDFRNS). We have investigated the triggers, usually described as ‘episodes’, to such relapses within a temporal context. Thirty-five patients with SDFRNS were analyzed retrospectively. A total of 442 relapses occurred in 2499 patient-months. The relapses were classified into two groups: those with episodes (E+) and those without episodes (E−). There were 135 E+ relapses and 296 E− relapses. The common cold was the most common episode (52%) of E+ relapse, followed by school events (18%). These E+ relapses occurred almost evenly throughout the 4 weeks between each follow-up visit. Conversely, 161 (55%) of the 296 E−z relapses occurred within the 3-day period preceding the patient’s appointment (relapse-related hospital visit, RRHV). McNemar’s test revealed that the concentration of relapses in this period was statistically significant (P < 0.00011). In addition, 15 out of 26 RRHV without additional therapy showed a spontaneous remission. From a chronological perspective, the common cold and school events as well as up-coming hospital visits may trigger relapses in SDFRNS patients.

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References

  1. Hogg RJ, Portman RJ, Milliner D, Lemley KV, Eddy A, Ingelfinger J (2000) Evaluation and management of proteinuria and nephrotic syndrome in children: recommendations from a pediatric nephrology panel established at the National Kidney Foundation conference on proteinuria, albuminuria, risk, assessment, detection, and elimination (PARADE). Pediatrics 105:1242–1249
    Article CAS Google Scholar
  2. Toyabe S, Nakamizo M, Uchiyama M, Akazawa K (2005) Circannual variation in the onset and relapse of steroid-sensitive nephrotic syndrome. Pediatr Nephrol 20:470–473
    Article Google Scholar
  3. Reichlin S (1993) Neuroendocrine-immune interactions. N Engl J Med 329:1246–1253
    Article CAS Google Scholar
  4. Takahashi S, Wada N, Horinouchi K (2000) The relationship between mental stress and relapse in nephrotic syndrome: multiple questionnaire analysis. J Jpn Pediatr Soc 100:72–77 (in Japanese)
    Google Scholar
  5. Wingen AM, Muller-Wiefel DE, Scharer K (1985) Spontaneous remissions in frequently relapsing and steroid dependent idiopathic nephrotic syndrome. Clin Nephrol 23:35–40
    CAS PubMed Google Scholar
  6. Selye H (1951) An extra-adrenal action of adrenotropic hormone. Nature 168:149–150
    Article CAS Google Scholar
  7. Selye H, Tuchweber B, Rohan P (1965) Thromboses in large veins and pulmonary embolisms induced by catecholamines or serotonin. Nature 208:900–901
    Article CAS Google Scholar
  8. Szajnberg N, Krall V, Davis P, Treem W, Hyams J (1993) Psychopathology and relationship measures in children with inflammatory bowel disease and their parents. Child Psychiatry Hum Dev 23:215–232
    Article CAS Google Scholar
  9. Nomura T, Fukudo S, Muranaka M, Iwahashi S, Sasaki M, Satake M, Sasaki T, Shibata C, Matsumo S (1993) Impact of stress on serum gastrin in Zollinger-Ellison syndrome. Am J Gastroenterol 88:1432–1435
    CAS PubMed Google Scholar
  10. Sandberg S, Jarvenpaa S, Penttinen A, Paton JY, McCann DC (2004) Asthma exacerbations in children immediately following stressful life events: a Cox’s hierarchical regression. Thorax 59:1046–1051
    Article CAS Google Scholar
  11. Gulec AT, Tanriverdi N, Duru C, Saray Y, Akcali C (2004) The role of psychological factors in alopecia areata and the impact of the disease on the quality of life. Int J Dermatol 43:352–356
    Article Google Scholar
  12. MacDonald NE, Wolfish N, McLaine P, Phipps P, Rossier E (1986) Role of respiratory viruses in exacerbations of primary nephrotic syndrome. J Pediatr 108:378–382
    Article CAS Google Scholar
  13. Satterwhite BB (1978) Impact of chronic illness on child and family: an overview based on five surveys with implications for management. Int J Rehabil Res 1:7–17
    Article CAS Google Scholar

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Authors and Affiliations

  1. Department of Pediatrics, Nihon University School of Medicine, 1-8-13 Chiyoda Ward, Kandasurugadai, Tokyo, 101-8309, Japan
    Shori Takahashi, Hitohiko Murakami, Satoshi Funaki & Kensuke Harada
  2. Division of Nephrology, Shizuoka Children’s Hospital, 860 Urushiyama, Shizuoka, Shizuoka, 420-0953, Japan
    Naohiro Wada
  3. Division of General Practice, Miyagi Children’s Hospital, 4-3-17 Ochiai, Aoba Ward, Sendai, Miyagi, 989-3126, Japan
    Tetsuji Inagaki
  4. Department of Pathology, Institute of Basic Medical Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan
    Michio Nagata

Authors

  1. Shori Takahashi
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  2. Naohiro Wada
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  3. Hitohiko Murakami
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  4. Satoshi Funaki
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  5. Tetsuji Inagaki
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  6. Kensuke Harada
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  7. Michio Nagata
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Correspondence toShori Takahashi.

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Takahashi, S., Wada, N., Murakami, H. et al. Triggers of relapse in steroid-dependent and frequently relapsing nephrotic syndrome.Pediatr Nephrol 22, 232–236 (2007). https://doi.org/10.1007/s00467-006-0316-y

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