Predictive risk factors of steroid dependent nephrotic syndrome in children www.nephropathol.com DOI: 10.15171/jnp.2017.31 J Nephropathol. 2017;6(3):180-186 Journal of Nephropathology *Corresponding author: Maher Ahmed Abdel-Hafez, Email: Maher_ahmed_2005@yahoo.com Maher Ahmed Abdel-Hafez * , Nagy Mohamed Abou-El-Hana, Adel Ali Erfan, Mohamed El-Gamasy, Hend Abdel-Nabi Pediatric Department, Faculty of Medicine, Tanta University, Egypt Original Article ARTICLE INFO Article type: Original Article Article history: Received: 11 November 2016 Accepted: 20 January 2017 Published online: 2 February 2017 DOI: 10.15171/jnp.2017.31 Keywords: Nephrotic syndrome Children Prediction Steroid dependency Background: Development of steroid dependency is one of the difficult problems in the management of children with idiopathic nephrotic syndrome, leading to increased morbidity, complications and cost of treatment. Thus, predicting early in the disease course will be useful in counseling parents and may improve treatment strategy. Objectives: To determine the clinical characteristics that can predict the development of steroid dependency early in the initial episodes of steroid sensitive nephrotic syndrome (SSNS). Patients and Methods: The study included 52 children with SSNS. Their ages ranged from 3 to 16 years. Patients were divided into two groups. Group A consisted of 24 patients with steroid dependency or frequent relapses nephrotic syndrome and group B consisted of 28 patients with complete remission or recurrent nephrotic syndrome. Data obtained retrospectively from patients’ files. Results: Children who require a cumulative steroid dose equal or more than 140 mg/kg to maintain remission during the first 6 months of the disease are at high risk to require steroid sparing agents (SSA) for disease control, and who did not achieve remission by day 20 of the initial prednisone course became steroid dependent with 96% specificity but with low sensitivity (50%). All steroid dependent children in this study showed relapses associated significantly with upper respiratory tract infections. Conclusions: Cumulative steroid dose in the first 6 months of treatment and the need of more than 20 days to achieve initial remission can predict steroid dependency in children with nephrotic syndrome. ABSTRACT Implication for health policy/practice/research/medical education: The results of this article can help health managers to improve protocols of managements of idiopathic nephrotic syndrome in children by prediction of steroid dependency early in the disease course and can help in parents counsellings as well. Please cite this paper as: Abdel-Hafe MA, Abou-El-Hana NM, Erfan AA, El-Gamasy M, Abdel-Nabi H. Predictive risk factors of steroid dependent nephrotic syndrome in children. J Nephropathol. 2017;6(3):180-186. DOI: 10.15171/jnp.2017.31. 1. Background The prognosis of children with idiopathic nephrotic syndrome depends on the underlying histopathology and can be predicted by the response to steroid treatment. Biopsy has proven focal segmental glomerulosclerosis (FSGS) and steroid resistant nephrotic syndrome (SRNS) are signifcantly associated with poor outcome including progression to end-stage renal disease (ESRD) (1). Most patients with minimal change disease (MCD) achieve remissions by two weeks of steroid therapy. The disease recurs in more than 75% of subjects and almost half show frequent relapses or steroid dependency (2). The associations of steroid dependency with young age at onset, male gender, the duration from initial steroid therapy to remission, low serum protein levels and hematuria have been investigated with conficting results in different population groups (3-7). Although the higher