&lt;p&gt;Prevalence rates of histopathologic subtypes associated with steroid resistance in childhood nephrotic syndrome in Sub-Saharan Africa: a systematic review&lt;/p&gt;

Uwaezuoke, Samuel N; Ndu, Ikenna K; Mbanefo, Ngozi R

doi:10.2147/ijnrd.s207372

Cited by 7 publications

(6 citation statements)

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“…[7][8][9][10][11][12] Furthermore, a recent systematic review had con rmed high prevalence rates of histopathological subtypes associated with steroid resistance in sub-Saharan African setting. 13 In Nigeria, although previous studies found a similar trend, 14,15 recent ndings from other regions of the country have reported a rise in the incidence of SSNS. [16][17][18] In Enugu, the epidemiological pattern of childhood nephrotic syndrome was reported 2 decades ago by Okoro et al 19 However, there is no recent study in this locality indicating the current pattern or a similar rise in the incidence of SSNS as reported elsewhere in Nigeria.…”

Section: Introductionmentioning

confidence: 82%

Rising incidence of steroid-resistant nephrotic syndrome in childhood: a 5-year retrospective observational descriptive study in a south-east Nigerian tertiary hospital

Mbanefo

Uwaezuoke

Muoneke

et al. 2022

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Introduction: Nephrotic syndrome is the commonest glomerular disease of childhood. Majority of the idiopathic cases frequently respond to steroid therapy and are regarded as steroid-sensitive nephrotic syndrome (SSNS). Several studies have reported a change in this usual pattern to steroid-resistant nephrotic syndrome (SRNS) in Nigerian children.Aim: This study aims to determine if there is a rising incidence of SRNS in children seen at a tertiary hospital in Enugu, south-east Nigeria. Subjects and methods: A retrospective observational descriptive study was conducted in children with nephrotic syndrome seen at the University of Nigeria Teaching Hospital, Ituku-Ozalla Enugu, over 5 years (from 2016 to 2020). The demographic variables, clinical data (including steroid-sensitive and renal-transplant cases) and histopathological pattern (including indications for renal biopsy) were documented using a study proforma. Results: Out of a total of 150 patients, 105 (70%) were males while 45 (30%) were females. Ninety-six (64%) were aged between 1-10 years whereas fifty-four 54 (36%) were adolescents aged 11 - 18 years. Forty-eight (32%) were aged 1 - 5years. Their mean age was 8.67 ± 4.69 years. One hundred and eighteen (78.7%) had idiopathic nephrotic syndrome while 21.3% had secondary nephrotic syndrome from post-streptococcal glomerulonephritis (16/32, 50%) lupus nephritis (6/32, 18.7%), sickle-cell nephropathy (5/32, 15.6%), HIV-nephropathy (3/32, 9.4%), and hepatitis B infection (2, 6.3%). One hundred and six (71%) initially had SSNS; twelve (11.3%) and seven (6.6%) later became frequent-relapsers and steroid-dependent, respectively. Forty-four (29.3%) patients initially had SRNS. Sixty-eight patients had renal biopsy; the commonest indication being steroid-resistance. The commonest histological pattern was focal segmental glomerulosclerosis (FSGS), seen in 63.2% of these patients. Only four (9%) had renal transplant. Conclusion: Although the prevalence of SSNS is higher in this clime, there is a rising incidence of SRNS. This trend may be attributed to incident cases of FSGS.

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Section: Introductionmentioning

confidence: 82%

Rising incidence of steroid-resistant nephrotic syndrome in childhood: a 5-year retrospective observational descriptive study in a south-east Nigerian tertiary hospital

Mbanefo

Uwaezuoke

Muoneke

et al. 2022

Preprint

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“…This rise in the incidence of FSGS has been documented in a systematic review of childhood nephrotic syndrome in SSA, including studies from Nigeria, Ghana, the DRC and South Africa, as well as in studies from paediatric patients within the United States. [12][13][14][15]24,[33][34][35][36][37] In fact, within a South African paediatric cohort, FSGS was the most common lesion among patients with steroid-resistant disease. [38] NPHS2 V260E mutations were found to predict steroid resistance in a cohort of South African children with FSGS and, in a genetic study of European RESEARCH patients with African ancestry, mutations in the APOL1 G1 and G2 alleles were seen at a higher frequency in patients with FSGS pathology, suggesting associations between genetic makeup and histopathological diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Response to corticosteroid treatment in paediatric nephrotic syndrome: A retrospective review from Mozambique

et al. 2021

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This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.Nephrotic syndrome is one of the most common causes of kidney disease in paediatric patients, with disadvantaged populations suffering disproportionately from the disease and its complications. [1][2][3] Data on the clinical profile of paediatric nephrotic syndrome, a chronic condition characterised by proteinuria, hypoalbuminaemia, and oedema, are limited within sub-Saharan Africa (SSA). [4] Consequently, medical management and outcomes of paediatric patients with nephrotic syndrome across SSA are not well established, especially for cases of steroidresistant disease.Early age at onset is associated with an increased prevalence of steroid-resistant nephrotic syndrome (SRNS) in children. Based on information collected from the PodoNet Consortium international registry including 1 655 paediatric patients, childhood-onset SRNS manifested before the age of 5 in 64% of patients. [5] Historically, more than 50% of these patients with steroid resistance had progressed to chronic kidney disease (CKD) and end-stage renal disease (ESRD) within five years, particularly within resourcelimited settings. [6] Until the 1980s, quartan malaria nephropathy was prevalent in tropical regions of Africa, making corticosteroidresistant disease common throughout the region. [4] However, given improving access to healthcare for the treatment of malaria, nephrotic syndrome is now increasingly associated with other disease processes, including hepatitis B, HIV, sickle cell disease and systemic lupus erythematosus. [7][8][9] Response to steroid therapy has also been reported to differ according to geography. [6,10] Studies concerning associations of SRNS with ethnicity present varying conclusions. Retrospective chart reviews reported higher rates of SRNS at institutions in the Democratic Republic of the Congo and Nigeria than those reported in Asian or Western countries (around 10%). [11][12][13][14] Conversely, two recent studies in Nigeria showed improved steroid-sensitivity in cohorts of children. [15,16] Moreover, studies from Zimbabwe, Malawi and South Africa show a continued predominance of focalsegmental glomerulosclerosis (FSGS) and membranoproliferative glomerulonephritis (MPGN) in the region, a histopathologic diagnosis commonly associated with the steroid-resistant disease. [17][18][19] Considering the lack of a definitive association with SRNS within current literature, further characterisation of the clinical profile of SRNS is needed.The present study aims to address this gap by characterising the baseline clinical and demographic factors associated with steroid resistance in a cohort of Mozambican children with nephrotic syndrome.Background. First-line treatment for paediatric nephrotic syndrome, a chronic disease characterised by proteinuria, hypoalbuminaemia and oedema, is corticosteroid therapy. An association between African ethnicity and steroid resistance has been reported, but published data from sub-Saharan Africa are limited and lack...

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“…5 Childhood INS is usually caused by any of these glomerulonephritides: minimal change nephropathy (MCN), focal segmental glomerulosclerosis (FSGS), membranoproliferative glomerulonephritis (MPGN), membranous nephropathy (MN) and mesangial proliferative glomerulonephritis (MesPGN). 6 Both FSGS and MCN are the prevalent histopathologic lesions worldwide. 5 A previous report indicates that the latter is the predominant lesion among preadolescent children in developed countries.…”

Section: Introductionmentioning

confidence: 99%

“…7 Still, the prevalence of the former is rising in childhood in both developed and developing countries. 6,[8][9][10][11][12] Whereas the response of minimal-change nephrotic syndrome (MCNS) to corticosteroids appears predictable with a good prognosis, nephrotic syndrome due to FSGS is largely steroid-resistant with a poor prognosis, and may progress to end-stage kidney disease (ESKD). Alternative immunosuppressive drugs are also effective in FSGS.…”

Section: Introductionmentioning

confidence: 99%

<p>The Supportive Treatment of IgA Nephropathy and Idiopathic Nephrotic Syndrome: How Useful are Omega-3 Polyunsaturated Fatty Acids?</p>

Uwaezuoke¹,

Muoneke²,

Mbanefo³

2020

IJNRD

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IgA nephropathy (IgAN) is the most prevalent glomerular disease in young adults worldwide, while idiopathic nephrotic syndrome (INS) represents the most frequent manifestation of glomerular disease in childhood. Over the years, studies have speculated about the potential benefits of omega-3 polyunsaturated fatty acids (PUFAs) in improving morbidity in both forms of chronic kidney disease (CKD). The proposed mechanisms of action include reduction of proteinuria and modulation of dyslipidemia. Although in vitro and in vivo experimental studies report the suppressive effect of omega-3 PUFAs on inflammatory pathways linked with the progression of nephropathy, the evidence supporting their beneficial effect in IgAN and INS is still weak. Also, their ability to regulate levels of total cholesterol, low-density lipoprotein-cholesterol (LDL-C), and triglycerides (TG) suggests that they could delay both dyslipidemia-associated nephrotoxicity and atherosclerosis. Most of the clinical trials that were conducted on their therapeutic benefits in IgAN patients reported positive outcomes with low and high doses of omega-3 PUFAs. However, few of the trials noted inconclusive findings, with low-quality evidence suggesting potential improvements in surrogate renal function outcomes. If the beneficial effect of omega-3 PUFAs is predicated on their hypolipidemic action, much higher doses could be used in welldesigned randomized-controlled trials (RCTs) to determine if they could produce better renal function outcomes and provide much stronger evidence of their therapeutic benefits in IgAN and INS. However, the current hypothetical mechanisms of action in these forms of CKD also include the effect of omega-3 PUFAs on renal inflammatory pathways and glomerular proteinuria. Perhaps, the unresolved therapeutic efficacy of these fatty acids in IgAN and INS suggests that their exact mechanisms of action are yet to be fully established. In this narrative review, we aim to appraise the current evidence of their potential therapeutic benefits in these diseases.

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<p>Prevalence rates of histopathologic subtypes associated with steroid resistance in childhood nephrotic syndrome in Sub-Saharan Africa: a systematic review</p>

Cited by 7 publications

References 57 publications

Rising incidence of steroid-resistant nephrotic syndrome in childhood: a 5-year retrospective observational descriptive study in a south-east Nigerian tertiary hospital

Rising incidence of steroid-resistant nephrotic syndrome in childhood: a 5-year retrospective observational descriptive study in a south-east Nigerian tertiary hospital

Response to corticosteroid treatment in paediatric nephrotic syndrome: A retrospective review from Mozambique

<p>The Supportive Treatment of IgA Nephropathy and Idiopathic Nephrotic Syndrome: How Useful are Omega-3 Polyunsaturated Fatty Acids?</p>

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