Childhood Nephrotic Syndrome in Uyo Nigeria Challenges of Management in a Resource Limited Setting

Childhood nephrotic syndrome is a common glomerular disorder with massive proteinuria. Interplay of sociodemographic factors, variation in clinical presentation, steroid responsiveness and access to steroid-sparing therapy has remarkable impact on its outcome. The presentation and management outcome of nephrotic syndrome in a resource limited setting were reviewed. Data was obtained from the renal register of the paediatric renal unit of University of Uyo Teaching Hospital, Uyo, Nigeria from January 2007 to December 2016. Fifty-five children aged 9 months to 17 years with a mean age of 10.1±4.7 years formed the study population. Peak age was 14-15 years with a gender distribution of 36 males (65.5%) and 19 females (34.5%) giving a M:F ratio of 1.9:1. Sixty percent of the patients belonged to the low socio-economic class. Significant clinical features were: generalised oedema (94.5%), hypertension (67.3%), oliguria (65.5%) and microscopic haematuria (50.9%). Complications included pulmonary oedema and encephalopathy (9.1% each), severe anaemia (5.5%) and primary peritonitis (2.6%). Serum creatinine could be done in 89.1% and estimated 2 glomerular filtration rates were as low as £15mls/1.73m /min in 10.9% of the patients. Possible secondary aetiologies were Hepatitis B and C {(6/34) 17.6%} and {(4/34) 11.8%} respectively), sickle cell anaemia {(3/20) 15%} and human immunodeficiency virus {(2/35) 5.7%}. Renal biopsy was indicated in all the 17 steroid resistant patients but was not affordable. Overall, favourable steroid response (remission) was documented within 7-42 days in 21 (38.2%)of the patients and 17 (30.9%) were steroid resistant. The remaining 17 (30.9%) did not continue long enough in care to ascertain their response to steroid therapy. Further remission with cyclophosphamide occurred in 7/17 (41.2%) of the steroid resistant group. Thirteen patients (23.6%) of the total study population required renal replacement therapy. Only 5/13 (38.5%) could afford between two and eight sessions of haemodialysis, out of which 2/5 (40%) recovered renal functions. Financial constraint was a prominent factor in the poor outcome of our study population. Subsidised treatment of childhood nephrotic syndrome in our locale is therefore recommended.