Steroid Response Pattern Among Children with Nephrotic Syndrome in Northern Ethiopia

Abstract

Background: Nephrotic syndrome is the most common glomerular disease affecting children, characterized by heavy proteinuria, edema, hypoalbuminemia, and hyperlipidemia. The mainstay treatment is with prednisolone, whose response is of prognostic significance. Steroid response rates vary across geographical regions, which may be due to the role of genetic and environmental risk factors among different ethnic groups. There is a paucity of data on response to treatment with prednisolone in pediatric patients with nephrotic syndrome in the Tigray region, Northern Ethiopia. Objectives: To assess the pattern of response to prednisolone in pediatric patients treated for nephrotic syndrome at Ayder Comprehensive Specialized Hospital from 2014 to 2019. Methods: A record-based retrospective study was conducted at Ayder Comprehensive Specialized Hospital Mekelle City, Ethiopia. Data was collected and recorded on a predesigned form. Sixty-three patients fulfilled the inclusion criteria, whose data was entered, coded, and analyzed using the statistical software package (SPSS) version 20. Variables of interest included age, gender, blood pressure, presence of hematuria, acute kidney injury, biopsy, secondary causes of nephrotic syndrome, and response to steroid therapy. Data was presented in tables and graphs. Results: The age of the patients ranged from 1 - 17 years, with a median age of 3 years. Fifty-one patients (81%) were males, with a male to female ratio of 4.2:1. Hematuria was present in 66.7%, whereas hypertension was seen in 49.2% of the patients. Thirty-nine patients (61.9%) were responsive to prednisolone, 24 cases (38.1%) were resistant, 8 (20.5%) were steroid-dependent and 19 (48.7%) had relapses. Younger age (AOR 16.671, 95% CI: 1.645 - 168.904 P = 0.017) and high cholesterol values (AOR 1.013, 95% CI: 1.005 - 1.021 P = 0.01) were independent factors associated with steroid responsiveness. Conclusions: The steroid response rate in this study is similar to that in Asian and some African countries. Most patients in our hospital had atypical features of nephrotic syndrome. Younger age and high cholesterol levels were independent factors affecting steroid response.

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

“… 28 , 29 In this study, 5.7% of the patients were resistant to steroid therapy throughout the follow-up period. Our findings are lower than the findings of resistant NS in African studies; 26.1% in Nigeria, 24 38.1% in Ethiopia, 23 42.6% in South Africa, 22 and an average of 25.3% in African children. 30 It is also lower than 10–15% resistant NS reported in a review by Tullus et al 29 The possible explanation for a lower rate of steroid-resistant NS in our study may be the difference in age, ethnicity, histopathologic type, or the difference in the study design.…”

“…This finding is similar to the 90–95% rate of response to steroid therapy in minimal change NS children. 7 , 20 , 21 However, our finding is higher as compared to response rates of 57.7% in South Africa, 22 61% in Ethiopia, 23 63% in tropical Africa, 12 and 74% in Nigeria 24 achieved within 4 weeks of treatment. Achieving remissions with steroid therapy in 8 weeks is predictive of MCNS 3 suggesting most of our participants had MCNS.…”

“…For instance, the mean age of our study participants was 5.21 years whereas the mean ages of participants were 5.3 and 7.9 years in studies by Bakhiet et al 22 and Asinobi et al 12 respectively, and median age of 3 years in a study by Imbusi ea al. 23 Despite a good response rate with initial steroid therapy, our study found 73.6% relapse among the initial responders. This relapse rate is consistent with reports of the relapse rates between 60% and 90% among initial responder pediatric NS patients.…”

“…3 Our study revealed that the predictors for FR/SD NS with steroid therapy were younger age (≤6 years) at initial diagnosis (p=0.00), presence of hematuria (p=0.00), infection (p=0.01), acute renal failure (p=0.01), serum albumin below 1.5g/dl (p=0.01) at diagnosis and lack of remission within 2 weeks (p=0.0) of therapy. Similarly, other studies found a younger age at diagnosis, 23,25 presence of hematuria, 16,17,31 time to remission with initial therapy, and duration of steroid therapy, 16,17 presence of infection, 31 hypoalbuminemia 19 were independent predictors of relapse. The possible reasons for the variations may be differences in sociodemographics and clinical characteristics included participants and study methods employed.…”

“…For instance, the mean age of our study participants was 5.21 years whereas the mean ages of participants were 5.3 and 7.9 years in studies by Bakhiet et al 22 and Asinobi et al 12 respectively, and median age of 3 years in a study by Imbusi ea al. 23 …”