Incidence and predictors of relapse among children with nephrotic syndrome at Assosa zone hospitals, Benishangul Gumuz Region, Northwest Ethiopia, 2022

Background Relapse is the major problem in children with nephrotic syndrome and leads to a substantial burden on the patient and family worldwide, particularly in resource-limited countries like Ethiopia. However, little is known about the incidence of relapse and its predictors among children with nephrotic syndrome in the study area. Methods An institution-based retrospective follow-up study was conducted among 354 randomly selected nephrotic syndrome patients admitted from April 2017 to March 2022. Data entry was carried out using Epi-data manager version 4.6.0.6 and Stata software version 14 for data cleaning and analysis. Cox-proportional hazard models were used to identify predictors of relapse. Any variable with a p-value < 0.25 in the bivariable was taken into the multivariable analysis, and then the association and statistical significance were declared at P≤ 0.05. Results More than half, 55.8% (82/147), of relapses were recorded in the first six months of follow-up. The incidence of relapse was 82.3 per 1000 child-month-observations, with an overall risk of 1785.9 child-month-observations. In children with nephrotic syndrome, the presence of wasting malnutrition [AHR = 1.93, 95% CI 1.28–2.90], acute respiratory tract infections [AHR = 1.79, 95% CI 1.19–2.71], elevated triglyceride levels [AHR = 2.74, 95% CI 1.48–5.07], and low serum albumin levels [AHR = 4.34, 95% CI 22.18–8.64] were predictors of relapse. Conclusion and Recommendations The incidence of relapse among nephrotic syndrome patients was high. The independent predictors of relapse in children with nephrotic syndrome were the presence of acute respiratory tract infections, wasting malnutrition at admission, low serum albumin levels, and elevated serum triglyceride levels. Therefore, intervention to reduce and control earlier relapse should focus on preventing relapse-related complications. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was received from the school of nursing research ethical review committee on behalf of University of Gondar, institutional review board (IRB). Then, an official letter of cooperation was written to Assosa General Hospital and Menge Primary hospital from the school of nursing, department of pediatric and child health nursing on behalf of University of Gondar. Then, permission for data collection was obtained from each hospital's administration on behalf of patients, renal clinic, and pediatric wards of each hospital. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The original data for this study are available from the corresponding author upon reasonable request.