Nephrotic Syndrome in South African Children: Changing Perspectives in the New Millennium

Nandlal, Louansha; Naicker, Thajasvarie; Bhimma, Rajendra

doi:10.1016/j.ekir.2019.01.019

Cited by 21 publications

(17 citation statements)

References 44 publications

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“… 6 , 12 This is the most challenging form of NS associated with severe and prolonged proteinuria, high risk of complications, and mortality. 11 , 13 This form of NS is mostly resistant to corticosteroid therapy and other immunosuppressive treatment. 14 Besides, steroid-resistant NS is reported in 16–27% of African children, 6 , 15 which is about 2–4 times higher than rates in children of Asian and European descent.…”

Section: Introductionmentioning

confidence: 99%

Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Welegerima¹,

Feyissa²,

Nedi³

2021

IJNRD

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Background: Nephrotic syndrome is a common glomerular disease in children with a relapsing course that leads to complications and steroid-related toxicities. In Ethiopia, data on the outcomes of steroid therapy in pediatric nephrotic syndrome patients are limited. Objective: The aim of the study was to assess the treatment outcomes of pediatric nephrotic syndrome patients in Ayder Specialized Comprehensive and Mekelle General Hospitals. Methods: A retrospective study was conducted among children treated for nephrotic syndrome from 2010 to 2017 in Ayder Comprehensive Specialized and Mekelle General Hospitals. Univariate and multivariate logic regression analyses were performed to identify determinants of treatment outcome with a p-value <0.05 considered statistically significant. Results: A total of 159 pediatric patients treated for nephrotic syndrome in both hospitals were included in this study. The mean age of participants at the initial diagnosis was 5.21 ± 2.66 years. Most of the patients 150 (94.3%) achieved remission within 4 weeks of steroid therapy. Among initial responders, the majority of the patients 117 (78%) encountered relapses of which 65 (40.9%) were developed frequent relapse/steroid-dependent nephrotic syndrome. Also, the majority of patients 102 (64.5%) encountered steroid-related toxicities. The predictors of frequent relapse/steroid-dependent nephrotic syndrome were age of ≤6 years (AOR=3.16; p=0.00), hematuria (AOR=6.74; p=0.00), infection (AOR=3.28; p=0.01), acute renal failure (AOR=6.09; p=0.01), serum albumin below 1.5g/dl (8.38, p=0.01) and lack of remission within 2 weeks (AOR=3.69; p=0.00). Conclusion:Most of the pediatric NS patients treated in ACSH and MGH have achieved remission with initial to steroid therapy. However, there was a higher relapse rate and steroidrelated toxicities among pediatric NS patients who achieved remission. Early age at diagnosis, hematuria, reduced GFR, infection, and remission time were the independent predictors of the frequent relapsing/steroid-dependent nephrotic disease course.

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Section: Introductionmentioning

confidence: 99%

Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Welegerima¹,

Feyissa²,

Nedi³

2021

IJNRD

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“…Studies in multiracial countries such as the United States of America and South Africa indicate that children of Sub-Saharan African (SSA) ancestry have steroid resistance rates 2-4 times higher than rates in children of Asian and European descent [9][10][11][12]. These observations influence the management of Black children with nephrotic syndrome including discussions about its clinical course and long-term prognosis with the families [13].…”

Section: Introductionmentioning

confidence: 99%

Changing epidemiology of nephrotic syndrome in Nigerian children: A cross-sectional study

2020

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Background Recent reports from small studies in West Africa suggest that Black children may have high rate of steroid sensitivity nephrotic syndrome (SSNS) contrary to long held knowledge. Herein, we determined the proportion of children with idiopathic nephrotic syndrome (INS) who achieved complete remission with steroid therapy and identified factors associated with complete remission. Methods We reviewed the medical records of 241 children with INS in two centres in Lagos from 2010 to 2019. We extracted demographic data, clinical features, laboratory values at the time of diagnosis, and receipt and response to steroids and other immunosuppressants. Results The median (interquartile range) age at diagnosis of INS was 5.1 (3.0-8.7) years and boys were 60.2% of the study population. Children with SSNS made up 85.9% (n = 207) of the study cohort. Among those aged 0-5 years, 92.6%were SSNS compared with 69.2% in those aged 11-17 years at the time of diagnosis. In addition, the proportion of children with SSNS increased from 73.8% between year 2010 and 2012 to 88.4% afterwards. Also, children with SSNS had lower serum creatinine (0.44 vs 0.70; p<0.001) and higher estimated glomerular filtration rate (101 vs 74.3 ml/min/1.73 m 2 ; p = 0.008) at the time of diagnosis than those with steroid resistant nephrotic syndrome (SRNS).

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“…For instance, IgA nephropathy has a higher prevalence in eastern Asia including Japan, Singapore, and South Korea than North America (3). In areas with a high prevalence of hepatitis B such as Southern Africa, membranous nephropathy is the main cause of kidney biopsy, while it is rare in other areas (4). Furthermore, the frequency of other glomerulopathies such as membranous nephropathy and focal segmental glomerulosclerosis (FSGS) varies based on the geographic variability and access to medical care (5).…”

Section: Introductionmentioning

confidence: 99%

Pathologic findings of renal biopsies in children; an 11-year experience from a single center in West of Iran

2020

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Background: Renal biopsy is an important diagnostic procedure in pediatric nephrology. Although considered as an invasive method, numerous renal diseases cannot be definitively diagnosed and treated without it. Objectives: The aim of this study was histopathological study of renal biopsy results in children of 6 months to 18 years old. Patients and Methods: In this retrospective cross-sectional study, the available data from children who had undergone kidney biopsy between 2007 and the end of 2017 were evaluated. Demographic data, indications of biopsy, the outcome of patients, biopsy complications and histopathologic findings were collected using a checklist. Finally, data were presented as frequency and percentages. Results: The most common cause of biopsy in children was nephrotic syndrome (43.7%). Focal segmental glomerulosclerosis (FSGS) with 39 cases (32.7%) had the highest frequency in examined biopsies. In the long-term follow-up, 71 children (59.7%) cured, 7 (5.9%) died, 25 (21.0%) continued treatment, 6 (5.0%) underwent a kidney transplant surgery, and the outcome of 10 children (8.8%) was unknown. While 6.7% of patients were diagnosed with complications of biopsy, the most frequent of them was hematuria. There was no case of death or nephrectomy and only one patient needed packed RBC transfusion. Conclusion: Nephrotic syndrome was the most common indication for kidney biopsy. FSGS had the highest frequency in examined biopsies.

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Nephrotic Syndrome in South African Children: Changing Perspectives in the New Millennium

Cited by 21 publications

References 44 publications

Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Treatment Outcomes of Pediatric Nephrotic Syndrome Patients Treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia

Changing epidemiology of nephrotic syndrome in Nigerian children: A cross-sectional study

Pathologic findings of renal biopsies in children; an 11-year experience from a single center in West of Iran

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