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Abstract: PO1979

Rates of Idiopathic Childhood Nephrotic Syndrome Relapse During the COVID-19 Pandemic

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Crane, Clarkson, University of California San Diego, La Jolla, California, United States
  • Ingulli, Elizabeth G., University of California San Diego, La Jolla, California, United States
Background

While most children with idiopathic nephrotic syndrome (NS) enter remission after a course of steroid therapy, as many as 60-90% eventually relapse with recurrence of nephrotic-range proteinuria. Infections are thought to be primarily responsible for triggering relapses. The COVID-19 pandemic promoted physical distancing, facial masking, and greater attention to infection prevention measures resulting in decreased transmission of common viral infections. We hypothesize that there will be a decreased rate of NS relapse during this period.

Methods

We conducted a retrospective chart review of children with NS followed at our center. Patients were identified by ICD 9/10 code for proteinuria and included if they had primary steroid-sensitive NS. Numbers of relapses and hospitalizations each year were collected for baseline data, March 1, 2015-March 1, 2020, and for the social distancing period (SDP), March 1, 2020-March 1, 2021.

Results

137 children with NS were identified. The rate of relapse per year and the rate of hospitalizations per year were lower during the SDP compared with baseline pre-pandemic levels (76 vs 81 relapses per year and 14 vs 19 hospitalizations per year, respectively). Importantly, within a year of NS diagnosis, there was a baseline pre-pandemic average of 1.6 relapses per patient. This was much lower with an average of 0.6 relapses per patient during the SDP (p<0.01). In contrast, there was no difference in new diagnoses of NS comparing SDP vs baseline period (15 vs 14 new cases per year).

Conclusion

Our results support our hypothesis of lower rates of NS relapse and hospitalizations during SDP. Most notably, there were significantly fewer relapses within the year following NS diagnosis during SDP compared with baseline. This is likely attributable to decreased transmission of common infections and greater attention to infection prevention by caregivers. Less hospitalizations during the SDP would suggest decreased severity of relapse, perhaps due to earlier detection, increased caregiver awareness, or fewer infections. Interestingly, the number of new diagnoses was similar. Future analysis will focus on identification of relapse triggers and associations with steroid responsiveness and other demographic characteristics.