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Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Nephrotic syndrome, a common manifestation of kidney diseases in both adults and children, is characterized by proteinuria, hypoalbuminemia, edema, and hypercholesterolemia. Among the glomerular diseases causing nephrotic syndrome, podocytopathies such as minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are predominant. Glucocorticoids (GCs) remain the mainstay of therapy for these disorders, achieving high remission rates through their immunosuppressive and anti-inflammatory actions. However, prolonged or high-dose GC use is associated with significant adverse effects involving both physical and psychological domains. While somatic complications are well documented, neuropsychiatric and sleep-related side effects remain underrecognized, particularly in patients with nephrotic syndrome. This study aims to evaluate the frequency and dose-related patterns of steroid-induced psychiatric and sleep disturbances in adolescent and adult patients with nephrotic syndrome to support early detection and guide the use of steroid-sparing strategies.
This was a single-centre, prospective observational study conducted in the Department of Nephrology, PGIMER, Chandigarh, from January 2024 to June 2025. All consecutive adolescent and adult patients (>13 years) with nephrotic syndrome planned for initiation of corticosteroid therapy were screened. Patients with biopsy-proven minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS), or with a presumptive diagnosis of podocytopathy in adolescents, were included. Those with secondary causes of nephrotic syndrome, significant comorbidities, known psychiatric illness, or recent immunosuppressive use were excluded.
A total of 30 eligible patients were enrolled after informed consent. Baseline demographic, clinical, and biochemical data were recorded before initiation of corticosteroid therapy. Psychological and sleep parameters were assessed using the Brief Psychiatric Rating Scale (BPRS), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Pittsburgh Sleep Quality Index (PSQI). These scales were administered at baseline, 30, and 90 days after therapy initiation. Laboratory parameters including serum albumin, creatinine, and 24-hour urine protein were measured at each follow-up.
Cumulative steroid dose, disease response, and side effects were documented. Patients with significant psychiatric or sleep disturbances were evaluated by psychiatry, and steroid regimens were modified as clinically indicated. Data were analyzed to determine the incidence and dose-related association of corticosteroid-induced psychiatric and sleep disturbances and their relationship with disease subgroups and cumulative steroid exposure.
Of the 33 patients screened, 30 were analyzed (mean age 25.7 ± 14.6 years; 66.7% male). Diagnoses included Minimal Change Disease (40%), FSGS (33.3%), and unbiopsied nephrotic syndrome (26.7%). Fourteen (46.7%) presented with a first episode, 11 (36.7%) had infrequent relapses, and 5 (16.7%) were frequent relapsers. The mean baseline corticosteroid dose was 52.7 ± 13.6 mg/day. At 3 months, 86.7% achieved complete remission, while 10% relapsed during tapering. Sleep disturbances (PSQI) increased from 0% at baseline to 13.3% at 3 months. Minimal or mild depression (PHQ-9) rose from 40% at baseline to 56.7% at 3 months, while mild anxiety (GAD-7) developed in 13.3%. Frequent relapsers showed a trend toward worse sleep and depressive scores. Cumulative steroid dose showed significant positive correlation with PSQI (r = 0.47, p < 0.001), PHQ-9 (r = 0.30, p = 0.004), and GAD-7 (r = 0.32, p = 0.002), indicating a dose-dependent relationship between steroid exposure and psychological/sleep disturbances.
Parameters
Cumulative Dose Of Steroids In Prednisone Equivalents
p value
PSQI Total Score***
Correlation Coefficient (rho) = 0.47
<0.0011
PSQI Interpretation***
0.0182
Good
1535.73 ± 1456.54
Poor
2910.71 ± 1186.19
PHQ-9 Total Score***
Correlation Coefficient (rho) = 0.3
0.0041
PHQ-9 Interpretation***
0.0113
No Depression
1233.97 ± 1351.97
Minimal Depression
1792.38 ± 1592.02
Mild Depression
2567.00 ± 896.46
GAD-7 Total Score***
Correlation Coefficient (rho) = 0.32
0.0021
GAD-7 Interpretation***
0.0352
Minimal Anxiety
1517.79 ± 1435.78
Mild Anxiety
2766.67 ± 1460.31
Corticosteroid therapy in nephrotic syndrome is frequently accompanied by early-onset sleep and psychiatric disturbances, showing a clear dose-dependent association with cumulative steroid exposure. These effects were more pronounced in frequently relapsing cases, reflecting the additive impact of chronic disease and prolonged therapy. Routine use of validated screening tools such as PSQI, PHQ-9, and GAD-7 can facilitate early identification and management of neuropsychiatric side effects. Integrating psychological monitoring and steroid-sparing strategies into nephrotic syndrome care may enhance both mental health and treatment outcomes.
