Management of idiopathic childhood nephrotic syndrome in sub-Saharan Africa: Ibadan consensus statement

Esezobor, Christopher Imokhuede; Ademola, Adebowale D.; Adetunji, Adewale E.; Anígilájé, Emmanuel Adémólá; Batte, Anthony; Jiya-Bello, F; Fredrick, Francis; Muoneke, Uzoamaka; McCulloch, Mignon; Nourse, Peter; Obiagwu, Patience Ngozi; Odetunde, Odutola Israel; Okyere, Perditer; Solarin, Adaobi U; Tannor, Elliot Koranteng; Noone, Damien; Gbadegesin, Rasheed; Parekh, Rulan S.; Ashuntantang, Gloria; Guemkam, Georgette; Adu, Dwamoa; Adabayeri, Victoria; Boima, Vincent; Osafo, Charlotte; Antwi, Sampson; Plange‐Rhule, Jacob; Mamven, Manmak; Ajayi, Samuel; Okoye, Ogochukwu Chinedum; Okperi, Ofejiro; Ighosewe, Okiroro; Ulasi, Ifeoma; Okafor, Henrietta U.; Bl, Salako; Amodu, Kemi; Raji, Yemi Raheem; Adanze, Asinobi O.; Arogundade, Fatiu A.; Olowu, Wasiu A.; Olanrewaju, Timothy Olusegun; Adedoyin, Olanrewaju T.; Abdu, Aliyu; Amira, Oluwatoyin; Odenigbo, Charles; Jisieike-Onuigbo, Nonyelum Nnenna; Musa, Zaidat; Audu, Rosemary; Jinadu, Olanrewaju Yusuf; Makusidi, Muhammad A; Bello, Fatima Nma Jiya; Awobusuyi, J O; Ruggajo, Paschal; Shoo, Jacqueline; Kalyesubula, Robert; Kansiime, Grace; Vasilevska-Ristovska, Jovanka; Banh, Tonny; Wilson, J M; Smith, Donna; Ilori, Titilayo O.

doi:10.1016/j.kint.2020.07.045

Cited by 13 publications

(12 citation statements)

References 10 publications

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“…In the United Kingdom, a study had shown that NIS was 6 times more common in children of Asian origin than in European children [5]. In sub-Saharan Africa, nephrotic syndrome is the main cause of chronic renal failure and end-stage renal disease in children [6]. In multiracial countries, people of African descent have been shown to be at higher risk of developing steroid-resistant nephrotic syndrome [6] [7].…”

Section: Introductionmentioning

confidence: 99%

“…Nephrotic syndromes can occur at any age, but begins most often (in 90% of cases) in children under 10 years of age, often after an infectious or allergic trigger [5]. Kidney biopsy is indicated in cases of atypia: child under 1 year or over 12 years old, macroscopic hematuria, severe arterial hypertension, extrarenal signs, hypocomplementemia, renal failure, positive hepatitis serology [6] [8] [9]. Pathologically, minimal glomerular lesions present the most common appearance.…”

Section: Introductionmentioning

confidence: 99%

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Childhood Idiopathic Nephrotic Syndrome: A Single-Center Hospital Study

Doumbia¹,

Simaga²,

Dembelé³

et al. 2022

OJPed

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Introduction: Idiopathic nephrotic syndrome (INS) is one of the leading causes of childhood morbidity worldwide. This study was undertaken to complete the epidemiological, clinical, therapeutic and evolutionary aspects of NIS in hospitalized patients. Methodology: We conducted a retrospective study of patients with childhood NIS who had been admitted to our department from January 2017 to December 2018. Diagnosis, remission and relapse of idiopathic NS were defined according to the recommendations of the French Society of Pediatric Nephrology. We included all patients aged 2 to 14 years presenting a NIS picture. Results: During the study period, 35 patients with idiopathic NS had been hospitalized, representing a frequency of 1% of patients hospitalized in the department. The sex ratio was 2.22. The average age of the patients was 7.5 ± 3.5 years. Generalized edema was observed in all our patients. Arterial hypertension (36%) and abdominal pain (24%), hematuria (9%) were the main associated signs. Malnutrition was present in 66%, urinary tract infection in 20% and malaria in 24%. Cortico-sensitivity was obtained in 86% of patients, 14% were cortico-resistant and 11% were cortico-dependent. Relapses (6%) had been observed among cortico-sensitive patients. The mortality rate was 11%. Conclusion: This study calls for more trials to better elucidate prognostic indicators and develop better therapeutic approaches adapted to epidemio-clinical contexts.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Childhood Idiopathic Nephrotic Syndrome: A Single-Center Hospital Study

Doumbia¹,

Simaga²,

Dembelé³

et al. 2022

OJPed

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“…Both duration of the treatment and GS initial dose are matters of discussion. Two-, 3- and 6-month regimens have been used with conflicting data on the optimal treatment span [ 3 , 4 ], though recent studies [ 5 , 6 ] and guidelines [ 7 , 8 ]suggest short treatment duration in the majority of affected children.…”

Section: Introductionmentioning

confidence: 99%

Treatment of idiopathic nephrotic syndrome with two steroid dosing regimens – one-year observational study

Pańczyk-Tomaszewska

Skrzypczyk

Mroczkowski

et al. 2021

cejoi

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Introduction:The aim of the study was to compare the first year of disease in children with idiopathic nephrotic syndrome (INS) treated according to two prednisone dosing regimens: a weight-based schedule (2 mg/kg/24 h in the 1 st month, 2 mg/kg/48 h in the 2 nd month, with dose tapering during the following 4 months), and a body surface area (BSA)-based schedule (60 mg/m 2 /24 h in the 1 st month, 40 mg/m 2 /48 h in the 2 nd month, with dose tapering during the following 4 months).Material and methods: In 2 groups of children treated with weight-and BSA-based regimens (20 patients, 3.13 ±1.01 years, treated in 2010weight-and BSA-based regimens (20 patients, 3.13 ±1.01 years, treated in -2013weight-and BSA-based regimens (20 patients, 3.13 ±1.01 years, treated in and 20 patients, 5.13 ±2.86 years, treated in 2014weight-and BSA-based regimens (20 patients, 3.13 ±1.01 years, treated in -2016 clinical and anthropometrical parameters, number of INS relapses, total prednisone dose (mg/kg/ year), and steroid adverse effects were compared during the first year of disease.Results: Children treated with the weight-based steroid regimen received a higher total annual prednisone dose (259.06 ±79.54 vs. 185.83 ±72.67 mg/kg/24 h, p = 0.004) and had a shorter (though not significantly) period without prednisone (38.25 ±55.83 vs. 75.90 ±73.06 days, p = 0.062) compared to patients treated with the BSA-based regimen. There was no difference in number of relapses between groups (2.20 ±1.64 vs. 1.60 ±1.67, p = 0.190) but more patients relapsed in the weight-based group (19/20 vs. 13/20, p = 0.044). No differences in Z-score values of height, weight, and body mass index (BMI) were observed. No steroid-related adverse events were noted except for arterial hypertension (4/20 vs. 5/20 patients, p = 1.000). Conclusions:The BSA-based regimen of prednisone dosing in children with INS reduces exposure to steroids and risk of relapse, as well as increases days off steroids in the first year compared to the weight-based regimen with a high second-month dose.

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“…Most recently the Human Hereditary and Health in Africa-Kidney Disease Research Network (H3A-KDRN), generated a consensus statement on the management of childhood NS in sub-Saharan Africa using the modi ed Delphi approach to limit the observed variability in the management of childhood NS in Africa. [19] Among Caucasian children with NS, more than 85-90% of children are initially steroid sensitive and achieve remission within 4-6 weeks and 10-15% are initially steroid resistant (SR) [10,13,18]. The picture in Tropical Africa was characterized by paucity of MCD and steroid resistance in the 1960s to 1980s but recent reports are pointing to increasing steroid responsiveness in Sub-Saharan Africa as a whole [7,[20][21][22][23][24][25][26]).…”

Section: Introductionmentioning

confidence: 99%

“…[29,30] In low-and middle-income countries in Africa where patients may not afford the expensive alternative immunosuppressive agents this drug may be a useful alternative. [19,31] It is known that there are disparities in the epidemiology and response to treatment in various clinical conditions [32], it is therefore necessary to evaluate the e cacy of the drug in Africa and if found e cacious, it will improve access to appropriate management and quality of life of these patients.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy and Safety of Levamisole in African Children With Idiopathic Nephrotic Syndrome: A Protocol for Systematic Review and Meta-Analysis

Akwaowo¹,

Nna²,

Okafor³

et al. 2020

Preprint

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BackgroundNephrotic syndrome (NS) is one of the most common childhood renal disorders globally, with an incidence of 2 to 7 cases per 100,000 children. A characteristic feature is massive proteinuria which may rapidly progress to end stage kidney failure, if uncontrolled. Most of the cases in children are steroid sensitive but associated with frequent relapses. Levamisole, a cheap antihelminthic has been used as steroid sparing agent in steroid sensitive NS (SSNS). This study assesses the efficacy and safety of Levamisole in African children with idiopathic nephrotic syndrome.MethodsWe will conduct a systematic review and meta-analysis of all Randomised controlled trials which reported African children with Idiopathic nephrotic syndrome who were on Levamisole compared to other drugs. Ten databases including PubMed, African Journals Online, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Cochrane Library, Web of Science, Scopus, Clinicaltrial.gov and Research Gate will be searched using a search strategy. The search will have no time restrictions, but studies must have been conducted among African children residing in Africa and are retrievable in the English Language. Studies will be selected based on inclusion and exclusion criteria by two independent reviewers without blinding. The study quality will be assessed using the Pedro scale and risk of bias evaluated using the Cochrane Risk of Bias tool. Eligible screened studies will be inlcuded for meta-analysis using the CMA Software. Statistical, clinical and methodological heterogeneity will be tested. Subgroup analyses and meta-regression will be performed on rate of relapses, adverse event and drug dose.DiscussionThe primary outcome will be the proportion of children with remissions and or relapses within 6 -12 months post initiation of levamisole or comparators with effect size being the relative risk. Safety of Levamisole will be measured using reported adverse events. Moderating effects of age, gender, duration of illness, and dosage of Levamisole on the duration of remission, frequency of relapses and adverse events will be examined.Systematic Review RegistrationThis protocol has been registered in PROSPERO, with registration number CRD42020213327.

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Management of idiopathic childhood nephrotic syndrome in sub-Saharan Africa: Ibadan consensus statement

Cited by 13 publications

References 10 publications

Childhood Idiopathic Nephrotic Syndrome: A Single-Center Hospital Study

Childhood Idiopathic Nephrotic Syndrome: A Single-Center Hospital Study

Treatment of idiopathic nephrotic syndrome with two steroid dosing regimens – one-year observational study

The Efficacy and Safety of Levamisole in African Children With Idiopathic Nephrotic Syndrome: A Protocol for Systematic Review and Meta-Analysis

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