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

Abstract

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.

Incidence and predictors of relapse among children with nephrotic syndrome at Assosa zone hospitals, Benishangul Gumuz Region, Northwest Ethiopia, 2022

“…Accordingly, children who had an albumin level less ≤ 1.5 g/dl increased the hazard of relapse by 4.34 times as compared to those who had serum albumin levels ≥ 1.5 g/dl by adjusting the effect of other variables. This is in accordance with previous studies done in Ethiopia (14, 15), and Dhaka Medical College Hospital (DMCH) in Bangladesh (17). The possible explanation for the similarity might be due to the predominance of malnutrition in developing countries, which could create a favorable environment for the loss of albumin through urine.…”

“…The possible explanation for this discrepancy could be due to difference among the study population, ethnicity, duration of follow-up, and age at onset of the disease. Moreover, it was lower compared with reports of a relapse rate ranging from 48.7% to 78% among children with steroid-sensitive nephrotic syndrome in Ethiopia (15,28). This variation might be due to difference in sample size, study population, and presence of complication at diagnosis in the current study.…”

“…In Ethiopia, there are limited studies on the incidence of relapse and its predictive factors among children with nephrotic syndrome. However, it was the second most common cause of pediatrics admission due to renal disease with the relapse rate range from 35.6% to 78% (13)(14)(15). As a result of the disease process, relapses have a tremendous impact on various biological activities associated with protein loss during the active phase, which may lead to increased comorbidities, systemic complications, financial burden, and lower quality of life (1,16).…”

Treatment outcome of nephrotic syndrome and associated factors among Children at Public Specialized Hospitals of Bahir Dar City, northwest, Ethiopia: Retrospective study design

“…The possible discrepancy may be due to differences in age at diagnosis and histopathological differences since the majority of the participants in this study had no biopsy results, study design, or study period; in those countries, it was conducted as a long-term follow-up study. This study was higher than the studies done in Ethiopia, the Tigray region (5.7%), and France (7%) (32,33). This difference could be due to variability in health seeking behavior or delays in visiting hospitals, age at diagnosis, study design, sample size, and availability of advanced laboratory technology, as well as the difference in time to declare poor outcome or steroid resistance in France and the presence of complications at the time of initial diagnosis in this study area.…”

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

“…Ptosis, atrophy of the eyelid skin, keratitis, changes in the pigmentation of the macular area, and exacerbations of bacterial and viral infections are among the common adverse effects of steroids on the eyes. (3,4) . Our aim was to determine the prevalence of ocular problems in kids with nephrotic syndrome who were receiving steroid therapy or stopped the medication.…”