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

Abstract

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.