Predictors of Persistent Disease Activity in Childhood Minimal-Change Nephrotic Syndrome

Minimal Change Nephrotic Syndrome (MCNS) is a disease of childhood that follows a relapsing course but does not cause chronic kidney disease. The primary objective of this single center, retrospective chart review was to determine if there is an age beyond which patients with MCNS are more likely to achieve long-term remission. The secondary objective was to identify risk factors that can predict prolonged disease activity. The records of 43 children with MCNS were reviewed and the following data were tabulated: gender, age at diagnosis, age at last follow-up, duration of disease, medications used to treat MCNS, and the disease activity at last follow-up. In the full cohort of patients, there were 18 males and 8 females with active disease and 3 males and 14 females with inactive disease (P<0.002). In patients <10 years old, there were 11 males and 7 females with active disease and 0 males and 7 females with inactive disease, (P<0.01). In patients ≥10 years there were 7 males and 1 female with active disease and 3 males and 7 females with inactive disease (P<0.03). Over the full age spectrum, males were more likely to have active disease. There was no specific age at which the relapse frequency decreased significantly. There was no significant relationship between gender and activity of disease when comparing patients on MMF, tacrolimus, and rituximab, but there were 3 males and 1 female with active disease and no males and 6 females with inactive disease on prednisone alone (P<0.05). We conclude that there is no discrete age at which pediatric patients with MCNS are more likely to go into extended remission. Moreover, at any age, compared to boys, girls are more likely to go into long-term remission without requiring steroid sparing therapy.