Kidney function and mortality in childhood nephrotic syndrome
Bibliographic record
Abstract
BACKGROUND AND HYPOTHESIS: Nephrotic syndrome is a common childhood kidney disease. Frequent relapses, acute kidney injuries and immunosuppressive medications may lead to chronic kidney disease (CKD). Our objective was to determine incidence of kidney failure, CKD, cancer and mortality. METHODS: A systematic literature search was performed on five databases (MEDLINE, EMBASE, CENTRAL, Web of Science, ClinicalTrials.gov) for English abstracts and full-text articles from 1970 to 2024. Studies that enrolled children with idiopathic nephrotic syndrome (steroid-sensitive and -resistant) and reported kidney failure, CKD, cancer or mortality incidence were included. Data abstraction was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Meta-analyses calculated incidence rate (IR) of outcomes. RESULTS: Of 2785 studies screened, 229 were included (32 712 children). Median follow-up was 5.1 (range 0.3-29) years. Among children with steroid-sensitive nephrotic syndrome, incidence of kidney failure was IR 2.65 [95% confidence interval (CI) 1.55-4.54)], CKD was IR 3.80 (95% CI 2.38-6.07) and mortality was IR 2.30 (95% CI 1.14-4.63) per 1000 person-years. Among children with steroid-resistant nephrotic syndrome, incidence of kidney failure was IR 33.34 (95% CI 27.05-41.11), CKD was IR 46.90 (95% CI 39.31-55.96) and mortality was IR 12.52 (95% CI 8.21-19.09) per 1000 person-years. The most common causes of death were kidney failure and infections. The incidence of CKD and death decreased over time among children with steroid-resistant nephrotic syndrome. Cancer occurred in only 16 children in 13 studies (899 children). Many studies were at moderate-to-high risk of bias and used variable surveillance strategies and outcome definitions. CONCLUSIONS: Incidence of kidney failure, CKD and death are <4 per 1000 person-years among children with steroid-sensitive nephrotic syndrome. Children diagnosed with steroid-resistance had significantly higher incidence of CKD and death, although rates are decreasing over time. PROSPERO Registration: CRD42024578001 (19 August 2024).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.017 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.007 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".