Kidney Week

Abstract: FR-PO0828

Factors Associated with Sustained Remission of Nephrotic Syndrome in Children

Session Information

• Glomerular Diseases: Practice and New Concepts Shaping Modern Care
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Arora, Harshita, The Hospital for Sick Children, Toronto, Ontario, Canada

Harshita Arora

• Prabakaran, Sruti, The Hospital for Sick Children, Toronto, Ontario, Canada

Sruti Prabakaran

• Robinson, Cal, The Hospital for Sick Children, Toronto, Ontario, Canada

Cal Robinson, MBChB, PhD, FASN

• Aman, Nowrin F., The Hospital for Sick Children, Toronto, Ontario, Canada

Nowrin F. Aman, MBBS, MSc

• Banh, Tonny Hue Minh, The Hospital for Sick Children, Toronto, Ontario, Canada

Tonny Hue Minh Banh

• Brooke, Josefina A., The Hospital for Sick Children, Toronto, Ontario, Canada

Josefina A. Brooke, RN

• Bruno, Valentina, The Hospital for Sick Children, Toronto, Ontario, Canada

Valentina Bruno, MD, MS, MSc

• Chanchlani, Rahul, McMaster Children's Hospital, Hamilton, Ontario, Canada

Rahul Chanchlani, MD, MBBS, MS, FASN

• Dhillon, Vaneet, The Hospital for Sick Children, Toronto, Ontario, Canada

Vaneet Dhillon, NP, RN

• Garner, Mackenzie Alexander, The Hospital for Sick Children, Toronto, Ontario, Canada

Mackenzie Alexander Garner

• Licht, Christoph, The Hospital for Sick Children, Toronto, Ontario, Canada

Christoph Licht, MD, FASN

• McKay, Ashlene Maree, The Hospital for Sick Children, Toronto, Ontario, Canada

Ashlene Maree McKay, MD

• Noone, Damien Gerard, The Hospital for Sick Children, Toronto, Ontario, Canada

Damien Gerard Noone, MD, MSc

• Pearl, Rachel Jane, The Hospital for Sick Children, Toronto, Ontario, Canada

Rachel Jane Pearl, MD

• Radhakrishnan, Seetha, The Hospital for Sick Children, Toronto, Ontario, Canada

Seetha Radhakrishnan, MD

• Rasool, Keisha, The Hospital for Sick Children, Toronto, Ontario, Canada

Keisha Rasool, RN

• Selvathesan, Nithiakishna, The Hospital for Sick Children, Toronto, Ontario, Canada

Nithiakishna Selvathesan, MD, MBChB

• Teoh, Chia Wei, The Hospital for Sick Children, Toronto, Ontario, Canada

Chia Wei Teoh, MBChB, MSc

• Vanos Hosick, Kristen, The Hospital for Sick Children, Toronto, Ontario, Canada

Kristen Vanos Hosick, RN

• Vasilevska-Ristovska, Jovanka, The Hospital for Sick Children, Toronto, Ontario, Canada

Jovanka Vasilevska-Ristovska, MD

• Parekh, Rulan S., Women's College Hospital, Toronto, Ontario, Canada

Rulan S. Parekh, MD, MS, FASN

Group or Team Name

• INSIGHT Team

Background

Sustained remission (SR) is a key, patient-centered outcome in childhood nephrotic syndrome. However, a standardized definition of SR is lacking, and few studies evaluate factors influencing the timing of SR. We aimed to determine an optimal definition for SR and investigate factors associated with SR in childhood nephrotic syndrome.

Methods

Children (6 months-18 years) diagnosed with nephrotic syndrome between 1993-2023 from the Hospital for Sick Children and community hospitals in the Greater Toronto and Hamilton area were included. We evaluated different definitions of SR with varying relapse-free periods 1) off all immunosuppression and 2) on or off immunosuppression. We determined the risk of subsequent relapse after each defined period of SR, evaluating the timing and factors associated with age at and time to SR using Cox proportional hazards models.

Results

We included 1054 children with steroid sensitive nephrotic syndrome (median 3.8-years at diagnosis, 63% male, median 4.6-year follow-up). Using the 2022 International Pediatric Nephrology Association criteria, 880 (84%) children achieved this definition of SR, either with or without immunosuppression, yet 467 (53%) experienced further subsequent relapses. After a 2-year relapse-free period off immunosuppression, 29% relapsed. Relapse-free periods beyond 3 years were not associated with a substantially lower relapse risk. Median age at SR was 15.1 years (95%CI 14.1-16.3) and 61% of children achieved SR, without immunosuppression, before age 18. Older age at diagnosis, male sex, and receipt of ≥1 steroid-sparing medication were associated with an older age at SR.

Conclusion

Nearly two-thirds of children with nephrotic syndrome achieve SR before adulthood. Use of multiple steroid-sparing medications was the strongest predictor of delayed SR. A 2-year relapse-free period off immunosuppression is a reasonable surrogate for long-term remission, since relapses are common after shorter relapse-free intervals.

Funding

• NIDDK Support