Steroid response rate in childhood nephrotic syndrome at a tertiary hospital in South-Eastern Nigeria

Abstract

Background: Response to corticosteroids in childhood nephrotic syndrome (NS) remains the best prognostic marker of the disease. African children have been noted to respond poorly to corticosteroids. However, recent reports in some parts of Nigeria suggest high steroid responsiveness. Objectives: This study was done to determine the steroid response rate and associated clinical variables among children with NS in Umuahia, South-Eastern Nigeria. Patients and Methods: A retrospective, descriptive study of all the children managed for NS from June 2013 to June 2018 was retrieved and relevant information obtained. Data analysis was done using the SPSS software version 20.0 for Windows® (IBM SPSS Inc. 2011 Chicago, Illinois, USA). Results: A total of 30 children aged 2 years to 15 years with a median of 8 years were studied. Male-to-female ratio was 2:1. Fifteen patients achieved remission with steroid with remission rates of 50% overall and 62.5% among children with idiopathic NS. Patients that achieved remission had a lower mean age (mean difference = -5.13, confidence interval [CI] −7.73, −2.54; P < 0.001) compared to those that had steroid resistance. The frequency of steroid resistance in males was not different from females (odd ratio = 1, CI = 0.22–4.56; χ2 = 0.00 P = 1.00). Children aged 5 years and below had the highest remission rate, whereas those above the age of 10 years were all steroid resistant. There was no significant mean difference in the levels of serum albumin and total cholesterol among the children who achieved remission compared to nonresponders. Frequencies of hematuria, hypertension, and raised serum creatinine were not significantly different between the two groups. Conclusions: About two-thirds of children with idiopathic NS in our center achieve complete remission with steroid therapy, whereas about one-third have steroid resistance which predominates after the age of 10 years. Frequency of some clinical variables such as hematuria, hypertension, and raised serum creatinine did not significantly differ among steroid responders compared to nonresponders.

Keywords

• child
• nephrotic syndrome
• nigeria
• remission induction
• steroids