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Original ArticlesClinical Nephrology
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Two-Year Outcome of the ISKDC Regimen and Frequent-Relapsing Risk in Children with Idiopathic Nephrotic Syndrome

Koichi Nakanishi, Kazumoto Iijima, Kenji Ishikura, Hiroshi Hataya, Hitoshi Nakazato, Satoshi Sasaki, Masataka Honda, Norishige Yoshikawa and for the Japanese Study Group of Renal Disease in Children
CJASN May 2013, 8 (5) 756-762; DOI: https://doi.org/10.2215/CJN.09010912
Koichi Nakanishi
*Department of Pediatrics, Wakayama Medical University, Wakayama, Japan;
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Kazumoto Iijima
†Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan;
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Kenji Ishikura
‡Department of Nephrology, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan;
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Hiroshi Hataya
‡Department of Nephrology, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan;
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Hitoshi Nakazato
§Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan; and
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Satoshi Sasaki
‖Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Masataka Honda
‡Department of Nephrology, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan;
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Norishige Yoshikawa
*Department of Pediatrics, Wakayama Medical University, Wakayama, Japan;
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Summary

Background and objectives Early identification of frequently relapsing children with idiopathic nephrotic syndrome is desirable.

Design, setting, participants, & measurements The relapse status and clinical data of patients previously registered (January of 1993 to December of 2001) in a multicenter prospective study of the International Study of Kidney Disease in Children regimen were analyzed for risk of frequent relapsers over a 2-year follow-up period.

Results Of 166 children with nephrotic syndrome (113 boys and 53 girls; median age=5.1 years), 145 (87.3%, median age=5.5 years) children were steroid-sensitive, and 21 (12.7%, median age=2.9 years) children were steroid-resistant. Of 145 children with steroid-sensitive nephrotic syndrome, 32 (22.1%, median age=4.2 years) children experienced frequent relapses over 2 years. The time to initial response was significantly longer (10 versus 7 days, P<0.001, log-rank test) in the 32 frequent relapsers than in the 106 nonfrequent relapsers. The time from start of initial treatment to first relapse was significantly shorter (2.6 versus 6.1 months, P<0.001, log-rank test) in the 32 frequent relapsers than in the 57 infrequent relapsers. In a Cox regression model, the time to initial response ≥9 days and the duration from start of initial treatment to first relapse <6 months were significant predictors of frequent relapses (unadjusted and adjusted).

Conclusions Initial remission time ≥9 days and first relapse within 6 months were associated with frequent relapses. These findings may also be useful also in selecting potential frequent relapsers for clinical trials.

  • Received September 3, 2012.
  • Accepted December 21, 2012.
  • Copyright © 2013 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 8 (5)
Clinical Journal of the American Society of Nephrology
Vol. 8, Issue 5
May 07, 2013
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Two-Year Outcome of the ISKDC Regimen and Frequent-Relapsing Risk in Children with Idiopathic Nephrotic Syndrome
Koichi Nakanishi, Kazumoto Iijima, Kenji Ishikura, Hiroshi Hataya, Hitoshi Nakazato, Satoshi Sasaki, Masataka Honda, Norishige Yoshikawa, for the Japanese Study Group of Renal Disease in Children
CJASN May 2013, 8 (5) 756-762; DOI: 10.2215/CJN.09010912

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Two-Year Outcome of the ISKDC Regimen and Frequent-Relapsing Risk in Children with Idiopathic Nephrotic Syndrome
Koichi Nakanishi, Kazumoto Iijima, Kenji Ishikura, Hiroshi Hataya, Hitoshi Nakazato, Satoshi Sasaki, Masataka Honda, Norishige Yoshikawa, for the Japanese Study Group of Renal Disease in Children
CJASN May 2013, 8 (5) 756-762; DOI: 10.2215/CJN.09010912
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