Impact of Structured Pediatric Nephrology Care on Clinical Outcomes in Children with Nephrotic Syndrome at a Developing Tertiary Care Centre in North India

Abstract

Objectives: To evaluate the impact of introducing structured pediatric nephrology care on clinical outcomes of children with nephrotic syndrome at a developing tertiary care centre in North India. Methods: This Retrospective observational before-and-after study included children diagnosed with nephrotic syndrome during 2025. Patients managed from January–July formed the pre-intervention group, while those from August–December comprised the post-intervention group. The intervention included consistent implementation of Indian Society of Pediatric Nephrology (ISPN) steroid protocols, improved disease classification, structured parental training for home urine dipstick monitoring, and weekly WhatsApp-based remote monitoring. Outcomes were compared descriptively. Results: 14 children were included (6 pre-intervention, 8 post-intervention). Mean hospital stay decreased from 8 to 5 days, and median time to remission reduced from 12 to 8 days. Remission rates improved from 66.7% to 87.5%, relapse rates declined from 50% to 25%, and loss to follow-up reduced from 33.3% to zero. Referrals to higher centres were eliminated. No mortality occurred. Conclusion: Structured pediatric nephrology care improved clinical outcomes and follow-up adherence. Standardised protocols, parental involvement, and low-cost digital monitoring can enhance care delivery in developing tertiary settings.