Primary nephrotic syndrome in children in Cape Town, South Africa

Abstract

Background. Histopathological patterns of childhood primary nephrotic syndrome (PNS) and clinical response to steroids have been associated with certain race groups in parts of South Africa. However, there are no recent studies of childhood PNS in Cape Town.

Objectives. To describe the demographics, histological subtypes and steroid response of patients with PNS who underwent kidney biopsies at Red Cross War Memorial Children’s Hospital (RCWMCH) over a 10-year period.

Methods. Details of patients with PNS who underwent kidney biopsies in the Paediatric Nephrology Department at RCWMCH between 2006 and 2015 were retrospectively recorded.

Results. A total of 103 patients were included in the study. Most patients were either of mixed race (42%) or black (36%), with a mean age of 6.8 years and a male-to-female ratio of 1.19:1. The most identified histopathological subtype was mesangioproliferative glomerulonephritis (MesPGN; 60% (n/N=62/103)). Of the patients with focal segmental glomerulosclerosis (FSGS), MesPGN and minimal change disease (MCD) 45% (n/N=43/95) were steroid-resistant, and 54% (n/N=51/95) were steroid-sensitive. There was no significant association between any race group and steroid response. Patients with FSGS were more likely to be black, while MCD was more common in mixed-race patients (p=0.04). There was no difference in the likelihood of being mixed race or black between patients with FSGS and MesPGN (p=0.472).

Conclusion. MesPGN was the most common histopathological subtype found in our study. There was no significant association between race and steroid response. Patients with FSGS were more likely to be black than mixed race when compared with MCD patients. Race was not otherwise significantly associated with any histopathological subtype.