Abstract Minimal change disease, the most common cause of idiopathic nephrotic syndrome (INS) in chil- dren, has a high relapse rate, with approximately half of patients developing steroid dependency. This study was aimed at determining the predictive risk factors for the development of steroid dependency in children diag- nosed with INS. A retrospective study of 123 children with steroid-responsive INS, followed for at least 6 months between December 1974 and December 1999, was con- ducted. The following parameters were studied as pre- dictors of steroid dependency: age at onset, gender, race, microscopic hematuria at onset, atopy, concomitant up- per respiratory tract infections (URTI) during relapses, and days to remission with initial steroid therapy. Of the 91 children who fulfilled the inclusion criteria, 61.5% became steroid dependent. Both univariate and logistic regression analyses revealed that initial remission time of 9 or more days (P=0.02, OR=3.0, 95% CI=1.2–7.9) and concomitant URTI during relapses (P=0.01, OR=3.4, 95% CI=1.3–8.8) were significant predictors of steroid dependency. By identifying those children with predic- tive factors of steroid dependency, the clinician will be better able to plan the long-term management of these patients and reduce the morbidity seen with the frequent relapses and steroid treatment, in a disease that is other- wise associated with a favorable prognosis. Keywords Idiopathic nephrotic syndrome · Steroid dependency · Risk factors Introduction Idiopathic nephrotic syndrome (INS) is the most com- mon glomerulopathy in children, with an annual inci- dence of approximately 2–3 new cases per 100,000 pop- ulation under the age of 18 years [1]. Minimal change nephrotic syndrome (MCNS) is the most common cause of INS, especially in younger children, with a 2:1 predi- lection for boys. MCNS is associated with a more favor- able prognosis than the other histological variants [2, 3]. The recommendation of the International Study of Kidney Diseases in Children (ISKDC) for the treatment of MCNS is initial high-dose prednisolone of 60 mg/m 2 daily for 4 weeks, followed by 40 mg/m 2 on alternate days for another 4 weeks [4]. About 90% of children with MCNS will respond well to steroid treatment [5], going into complete remission. However, the rate of re- lapse is high (60%–75%), with half of those relapsing eventually becoming steroid dependent [6]. Frequent or continuous administration of steroids is usually effective in these steroid-dependent children, but is often associat- ed with complications such as posterior subcapsular cat- aracts, short stature, susceptibility to infections, gastritis, hypertension, obesity, and hirsutism [3], prompting the pediatrician to consider using cytotoxic drugs in order to discontinue steroid usage [7]. The aim of this study was to determine the predictive risk factors for the develop- ment of steroid dependency in children diagnosed with INS. Materials and methods The study group included 123 children who were diagnosed with steroid-responsive INS and followed at the Department of Pediat- rics, National University of Singapore between December 1974 and December 1999. The mean duration of follow-up was 7.6 years (range 6 months to 25 years). Before 1981, the initial steroid regimen used for treatment was based on a 40-day course of daily prednisolone as proposed by Arneil [8], whereas from 1981, the children were treated according to the ISKDC protocol [4]. Clinical relapse of INS was diagnosed when there was pro- H.-K. Yap ( ✉ ) Department of Pediatrics, National University Hospital, Lower Kent Ridge Road, Singapore 119074, Singapore e-mail: paeyaphk@nus.edu.sg Tel.: +65-7724411, Fax: +65-7797486 H.-K. Yap · E.J.S. Han · C.-K. Heng · W.-K. Gong Department of Pediatrics, National University of Singapore, Singapore Pediatr Nephrol (2001) 16:1049–1052 © IPNA 2001 ORIGINAL ARTICLE Hui-Kim Yap · Eugene J.S. Han · Chew-Kiat Heng Wei-Kin Gong Risk factors for steroid dependency in children with idiopathic nephrotic syndrome Received: 4 October 2000 / Revised: 27 August 2001 / Accepted: 28 August 2001