Are Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) Predictors of Steroid Therapy in Children with Nephrotic Syndrome?

Nephrotic syndrome (NS) is the most common pediatric chronic kidney disease characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Corticosteroids, as the mainstay of treatment, resolve symptoms in most patients. However, some patients experience a relapsing-remitting course. Currently, there is no specific biomarker for the prediction of steroid response in patients with NS. The neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are inexpensive, readily accessible parameters that are proved to be related to the inflammatory state in many disorders.

We evaluated NLR and PLR ratios before and after steroid therapy in 50 pediatric patients with NS in a single pediatric referral center. Data analysis was carried out using SPSS software and the significance level was considered as 0.05.

Medical response to steroid was compatible with steroid-dependent (SD) nephrotic syndrome (NS) in 30% (n=15), steroid-resistant (SR) NS in 12% (n=6), steroid-sensitive (SS) NS in 36% (n=18), and frequently relapsing (FR) NS in 22% (n=11). Fourteen patients (29.2%) did not experience recurrence. Before and after steroid therapy, the mean PLRs were 10.9 and 11.7 and the mean NLRs were 1.9 and 2.2, respectively, which were not statistically different (P>0.05).

We do not recommend NLR and PLR as predictors of steroid response in pediatric patients with NS.