Definition of Remission in Childhood Nephrotic Syndrome
Remission in children with nephrotic syndrome is defined as urine dipstick showing trace or negative proteinuria for at least 3 consecutive days. 1, 2
Standard Definition
The consensus definition across international guidelines establishes remission with the following criteria:
- Urine dipstick: trace/negative proteinuria for ≥3 consecutive days 1, 2
- Quantitative measurement: urine protein/creatinine ratio (uPCR) <200 mg/g (<20 mg/mmol) 1
- Alternative dipstick threshold: <1+ protein on urine dipstick for 3 consecutive days 1
Practical Application
For clinical practice, urine dipstick testing is the primary monitoring tool, particularly in resource-limited settings where quantitative testing may not be readily available. 1 The Ibadan Consensus Statement specifically emphasizes using "trace/negative for at least 3 consecutive days on urine dipstick only" as the practical definition. 1
Complete vs Partial Remission
While the guidelines primarily define complete remission as above, partial remission is recognized in steroid-resistant nephrotic syndrome (SRNS) when treated with calcineurin inhibitors (CNIs). 1 Partial remission indicates reduction in proteinuria but not to the complete remission threshold, and is sufficient to continue CNI therapy for at least 12 months. 1
Monitoring for Remission
- Daily urine dipstick testing should be performed during active treatment until remission is achieved 3
- First morning urine samples are preferred for consistency 1
- Once remission is achieved, regular home monitoring (at minimum weekly) should continue to detect early relapse 2
Important Caveats
Do not confuse the definition of remission with the definition of relapse, which requires ≥2+ proteinuria for 3 consecutive days (or ≥3+ in some guidelines) with or without edema. 1 The threshold for defining relapse is intentionally higher than the threshold for defining remission to avoid treating minor fluctuations in proteinuria.
The 3-consecutive-day requirement is critical - a single negative dipstick does not constitute remission and should not prompt changes in therapy. 1, 2