Association of Infections with Relapse in Steroid Sensitive Nephrotic Syndrome in Children

Abstract

Background: Steroid-sensitive nephrotic syndrome (SSNS) is the most common subtype of pediatric nephrotic syndrome, characterized by a high relapse rate, often precipitated by infections. Despite extensive documentation of infection types in SSNS, there is limited data on their correlation with relapse severity and treatment response in resource-limited settings such as Pakistan. Objective: To evaluate the frequency and types of infections in children with SSNS and assess their association with disease relapse and remission patterns, distinguishing between spontaneous and steroid-dependent recovery. Methods: This prospective analytical study was conducted at Combined Military Hospital, Rawalpindi, from January to December 2024. A total of 270 children aged 1–12 years with biopsy-confirmed SSNS presenting with acute infection were followed for relapse occurrence. Infections were clinically categorized, and patients were monitored for spontaneous versus steroid-induced remission. Statistical analysis was performed using SPSS v26, with p ≤ 0.05 considered significant. Results: Of 270 patients, 215 (79.6%) experienced relapse following infection. URTI (37.8%) and LRTI (21.1%) were the most frequent infections. Spontaneous remission occurred in 136 (63.2%) cases, while 79 (36.7%) required intravenous prednisolone. Diuretic use was significantly higher in the steroid group (p < 0.001, OR 5.54, 95% CI 3.13–9.81), although infection type did not significantly predict remission type. Conclusion: Infections, particularly respiratory tract infections, are major contributors to SSNS relapse. While most children achieve spontaneous remission, hypoalbuminemia and diuretic use are indicators of severe relapse requiring steroids.