Childhood Steroid-sensitive Nephrotic Syndrome: Characteristics and Predictors of Relapses (A Study at a Single Center in Khartoum)

Abstract

Background: Childhood steroid-sensitive nephrotic syndrome (SSNS) usually has a favorable outcome in spite of its relapsing course. The objective of the authors was to study the demographic and clinical characteristics, outcome and risk factors for relapses in children with SSNS at a single center in Khartoum, Sudan. Material and Methods: In this cross-sectional, facility-based study, the authors retrospectively reviewed all the records of children with SSNS, followed at the Pediatric Renal Unit, Soba University Hospital, Khartoum between 2001 and 2014. SSRNS was defined as the remission of proteinuria within 4–6 weeks of corticosteroids. Relapse is the recurrence of proteinuria after remission; frequent if ≥ 2 within initial six months or ≥ 4 within one year, and steroid dependence if 2 during therapy or within 14 days after stopping it. Results: 330 children (males 220; 66.7%) with SSNS were studied with a mean age of 5.2 ± 3.5 years of whom 42.4% aged 1–5 years. At the presentation, hypertension was detected in 31.8% and hematuria in 19.1%. Serum cholesterol was elevated in all patients (mean 347.34 ± 117.87 mg/dl) and serum creatinine in 7.27% (mean 1.4 ± 0.35 mg/dl). Renal histology showed mesangioproliferative glomerulonephritis (MesPGN) in 57.5%, minimal change disease (MCD) in 35.5%, and focal segmental glomerulosclerosis (FSGS) and IgM nephropathy in 3.5% each. During the course of the illness, 10.3% achieved long-term remission, 89.7% relapsed—of whom 52.3% had frequent relapsing/steroid-dependent (FR/SD) course and 37.7% had infrequent relapses. Risk of frequent relapses were age of onset and low/moderate socioeconomic status (P = 0.015 and 0.019, respectively). Infections were recorded in 71.8%, but not significantly associated with the risk of frequent relapses (P> 0.05). Conclusions: The majority children with SSNS at this single center in Khartoum had a relapsing course with the majority being FR or SD. Predictors of frequent relapses were young age at onset and low socioeconomic status.

Keywords

• nephrotic syndrome, steroid sensitive, relapse, children, Sudan