Study Finds No Clear Predictors for How Quickly Children with Nephrotic Syndrome Respond to Steroids
A new study from Nepal published in the BMC Nephrology found no obvious clinical variables to predict how quickly children with nephrotic syndrome respond to steroid treatment.
Nephrotic syndrome is the most common glomerular disease affecting children worldwide. It causes heavy protein loss in urine, leading to swelling, low blood protein levels, and increased risk of infections. Corticosteroids are the standard and most effective treatment, and most children are classified as having steroid-sensitive nephrotic syndrome (SSNS). However, the time taken to achieve remission varies widely, and doctors have few reliable tools to predict this response.
To address this, a study was conducted a year-long prospective observational study between June 2022 and May 2023. This study followed 54 children aged 1 to 14 years who were newly diagnosed with SSNS or experiencing a relapse. Families were instructed to perform daily urine albumin dipstick tests at home after starting standard steroid therapy, allowing researchers to closely track when remission occurred.
The findings revealed that most children responded fairly quickly. The average time to remission was just under 9 days. About 59% of the children achieved remission within nine days and were categorized as “early responders,” while roughly 41 percent required nine days or more and were labeled “late responders.”
The participant profile showed that the majority (over 80%) were experiencing their first episode of nephrotic syndrome, while the rest were relapse cases. Boys were twice as likely as girls to be affected, and the typical age at onset was around 5 years. These demographic patterns align with global trends in pediatric nephrotic syndrome.
This research also analyzed a wide range of clinical and laboratory features to see whether any could predict faster or slower recovery. These included age, sex, socioeconomic background, whether the episode was new or recurrent, and conditions such as anemia, acute kidney injury, hypertension, and microscopic blood in the urine. Laboratory measures such as serum creatinine, albumin levels, cholesterol levels, and severity of proteinuria were also examined.
Although children with hypertension and microscopic hematuria appeared to take slightly longer to recover, these differences were not statistically significant. Ultimately, none of the evaluated clinical or laboratory factors showed a meaningful association with time to remission. Overall, the results highlighted the complexity of steroid responsiveness in children with nephrotic syndrome.
Source:
Baral, R., Bhatta, M., Khan, S. A., Yadav, P., & Yadav, S. P. (2025). Predictors of time to remission in children with steroid-sensitive nephrotic syndrome: a prospective observational study in Nepal. BMC Nephrology. https://doi.org/10.1186/s12882-025-04699-8
