Prevalence and predictors of ocular complications among children undergoing nephrotic syndrome treatment in a resource-limited setting

Abstract

Background Nephrotic syndrome is the most common glomerulopathy among children aged 2–18 years and high dose corticosteroids are the backbone of its management. Potentially blinding ocular complications often result from nephrotic syndrome and/or its treatment. We conducted a study to determine the prevalence and predictors of ocular complications among children undergoing nephrotic syndrome treatment at Mulago National Referral Hospital. Methods This was a cross-sectional study conducted for three [3] months at the pediatric renal unit of Mulago National Referral Hospital (MNRH). Data from a consecutive sample of 100 children was collected using a semi-structured questionnaire, entered into Epi-data 4.4.2 and exported to STATA 14 for analysis at univariate, bivariate and multivariate levels. A robust Poisson regression model was used to identify predictors of ocular complications. Results Out of 100 patients examined, 80(80%) had ocular complications. The median age was 10 (IQR: 7–12) and 52 (52%) were girls. The most frequent complications were hypertrichosis and refractive errors in 71% (95%CI 61.1–79.6) and 56% (95%CI 45.7–65.9) of the patients respectively. Age above 10 years was the predictor for ocular complications with a RR = 1.37 (95%CI:1.14–1.64) p = 0.001. Conclusions We found a high prevalence of ocular complications among children with nephrotic syndrome in this tertiary hospital. The predictor of ocular complications was age greater than 10 years. We recommend that all children with nephrotic syndrome undergo a baseline ocular examination prior to commencement of treatment and be reviewed periodically by an ophthalmologist.

Assessment of Ocular Manifestations in Children with Nephrotic Syndrome during steroid Treatment

“…The least frequent manifestations were Epiblepharon in 4 patients (8.30%) and ptosis in 3 (6.3%) of patients. Our study is in agreement with Nakubulwa et al (7) who reported that a total of 80/100 (80%) participants had ocular complications. Seventy-one (71%) patients had hypertrichosis of the eye lashes, 56 (56%) had refractive errors, 37% had allergic conjunctivitis and 10% had blepharitis and bacterial conjunctivitis.…”

“…Hypertrichosis in our study was found in 25 patients (52.1%). This is in agreement with Nakubulwa et al (7) who found that hypertrichosis was the most frequent ocular complication in 70 patients (70%). Through an unidentified mechanism, systemic steroids promote facial hypertrichosis.…”

“…In our study blepharitis found in 26 children (54.2%). This contradicts the findings of the investigation by Nakubulwa et al (7) who found that the prevalence of blepharitis was 10%. Steroid-treated nephrotic syndrome patients may occasionally have an atypical immune system and bacterial eye infection Hayasaka et al (9) .…”

“…In our study one of the least frequent manifestations was Epiblepharon in 4 patients (8.30%). This is in disagreement with Nakubulwa et al (7) who found that 46 (46.6%) of Japanese kids with nephrotic syndrome had epiblepharon in his study. Hayasaka et al (9) reported that orbital fat projected further anteriorly in relation to the orbital rim in the lower eyelid and found that obesity and overweight were linked with Epiblepharon in children with nephrotic syndrome.…”

The Curative Effect of Shuangshen Decoction Combined with Immunological Preparations in the Treatment of Pediatric Nephrotic Syndrome and Its Influence on the Rate of Complicated Infection and Recurrence

“…The clinical efficacy of patients was evaluated according to the “Standards for Diagnosis and Efficacy of TCM Diseases and Syndromes” [ 21 ] and changes in clinical signs, 24 h urine protein quantification, and recovery of ALB indicators. Significantly effective means the obvious improvement of TCM symptoms and clinical signs and 24 h urine protein quantification ≤ 1.0 g, ALB ≥ 35 g/L.…”