Nephrotic syndrome in an urban south african paediatric population: a fifteen-year retrospective study of clinical, histopathologic pattern and treatment outcomes

Abstract

Background: Nephrotic syndrome (NS) is the commonest mode of presentation of glomerular disease in Africa. There is no single histological entity that underlies NS in Africa.

Objectives: To determine the clinicopathological patterns, and the outcome of nephrotic syndrome

Methods: Medical records of children with NS were reviewed.

Results: There were 147 children studied and 112(76.2%) were males. The mean age at presentation was 5.73±3.69 years. 134(91.2%) had idiopathic nephrotic syndrome. Majority were of the mixed race 124(84.4%). 119(83.8%) were steroid sensitive and 23(16.2%) were primary steroid resistant. Secondary steroid resistance was seen in 20(17.7%).The black race had higher rates of steroid resistance 8(66.7%) whereas the white 10(90.9%) and the mixed race 104 (88%) were more steroid sensitive. Minimal change disease (MCD) was commonest histological presentation 33(34.0%).The whites (4/8,50%) and the mixed race(28/84,33.3%) had high rates of minimal change. The black children had the highest proportions of mesangioproliferative GN (MesPGN) (5/7(57.1%) and similar rates of MCD and focal segmental glomerulosclerosis (FSGS) 14.3%. The mixed race had the highest proportion of FSGS 17/84(20.2%) Overall mortality was 3.4% and 6.3% had undergone transplantation.

Conclusion: MCD is the predominant pattern among the white and mixed race. FSGS is seen across all the races. Steroid resistance remains high among the black population

Keywords: Nephrotic syndrome, steroid sensitive, steroid resistant, children