553 - Comparing incidence and outcomes of nephrotic syndrome in Canadian-born vs immigrant children

Publication Number: 4541.553

Sophia E. Gorgiev, University College Dublin, Toronto, ON, Canada; Cal Robinson, The Hospital for Sick Children, Toronto, ON, Canada; Nowrin Aman, The Hospital for Sick Children, Toronto, ON, Canada; Jovanka Z. Vasilevska, The Hospital for Sick Children, Toronto, ON, Canada; Rulan Parekh, Women's College Hospital, Toronto, ON, Canada; Mackenzie Garner, The Hospital for Sick Children, Toronto, ON, Canada; Tanay Joshi, The Hospital for Sick Children, Toronto, ON, Canada; Tonny Banh, The Hospital for Sick Children, Toronto, ON, Canada; Josefina A. Brooke, the Hospital for Sick Children, Toronto, ON, Canada; Valentina Bruno, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Vaneet Dhillon, The Hospital for Sick Children, Toronto, ON, Canada; Christoph Licht, The Hospital for Sick Children, Toronto, ON, Canada; Ashlene McKay, The Hospital for Sick Children, Toronto, ON, Canada; Rachel Pearl, The Hospital for Sick Children, Toronto, ON, Canada; Seetha Radhakrishnan, The Hospital for Sick Children, Toronto, ON, Canada; Keisha Rasool, The Hospital for Sick Children, Toronto, ON, Canada; Nithiakishna Selvathesan, The Hospital for Sick Children, Toronto, ON, Canada; Chia Wei Teoh, The Hospital for Sick Children, Toronto, ON, Canada; Damien Noone, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada

Background: Nephrotic syndrome is one of the most common childhood kidney diseases, and incidence is highest among Asian and Black children. Immigrants to Canada are at increased risk of immune-mediated inflammatory diseases, but associations with childhood nephrotic syndrome are unknown.

Objective: Our aims were to evaluate the association between immigration and nephrotic syndrome incidence and outcomes.

Design/Methods: We included children (6 months-18 years) with nephrotic syndrome enrolled in INSIGHT, a prospective cohort in the Greater Toronto and Hamilton Area, Canada. The primary exposure was childhood immigration status prior to nephrotic syndrome diagnosis. Nephrotic syndrome incidence rate ratios were calculated by Poisson regression, using Statistics Canada Census data to determine the population at-risk. We evaluated associations between immigration status and steroid resistance, steroid-sparing medication use, and relapse patterns using multivariable regression models.

Results: Among 712 children with nephrotic syndrome, 90 (13%) immigrated to Canada prior to diagnosis, 50 (7%) immigrated after diagnosis, and 572 (80%) were Canadian-born. Nephrotic syndrome incidence was 3.7 per 100,000 person-years (95%CI 3.0-4.4) among immigrants and 2.0 (95%CI 1.8-2.2) among Canadian-born (rate ratio 1.84, 95%CI 1.49-2.24, p< 0.001). There were no significant differences between immigrants versus Canadian-born in the risk of steroid resistance, steroid-sparing medication use, frequent relapses or steroid dependence by 1-year after diagnosis, or relapse rate. Younger age at immigration to Canada was associated with earlier nephrotic syndrome diagnosis.

Conclusion(s): Immigrants to Canada have higher childhood nephrotic syndrome incidence but similar disease outcomes. The association between younger age at immigration and earlier nephrotic syndrome diagnosis suggest early environmental and immune exposures are key contributors to nephrotic syndrome risk.

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Table 2. Nephrotic syndrome outcomes by child immigration status prior to nephrotic syndrome diagnosis


Age at nephrotic syndrome diagnosis, stratified by age at child immigration
Figure 3 shows that younger age at child immigration ( <2-years) was associated with earlier age at NS diagnosis and older age at immigration (≥7-years) was associated with later NS diagnosis, compared to Canadian-born children.