Ladapo Taiwo Augustina, Esezobor Christopher Imokhuede, Lesi Foluso Ebun
Department of Paediatrics, College of Medicine, University of Lagos, PMB 12003, Lagos, Nigeria ; Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, PMB 12003, Lagos, Nigeria.
Int J Nephrol. 2014;2014:350640. doi: 10.1155/2014/350640. Epub 2014 Jul 16.
Recent reports from both Caucasian and black populations suggest changes in steroid responsiveness of childhood nephrotic syndrome. This study was therefore undertaken to determine the features and steroid sensitivity pattern of a cohort of black children with nephrotic syndrome. Records of children managed for nephrotic syndrome from January 2008 to April 2013 were reviewed. Details including age, response to treatment, and renal histology were analysed. There were 108 children (median age: 5.9 years, peak: 1-2 years), 90.2% of whom had idiopathic nephrotic syndrome. Steroid sensitivity was 82.8% among children with idiopathic nephrotic syndrome but 75.9% overall. Median time to remission was 7 days. Median age was significantly lower in steroid sensitive compared with resistant patients. The predominant histologic finding in resistant cases was focal segmental glomerulosclerosis (53.3%). No cases of quartan malaria nephropathy or hepatitis B virus nephropathy were diagnosed. Overall mortality was 6.5%. In conclusion, unusually high steroid sensitivity is reported among a cohort of black children. This is likely attributable to the lower age structure of our cohort as well as possible changing epidemiology of some other childhood diseases. Surveillance of the epidemiology of childhood nephrotic syndrome and corresponding modifications in practice are therefore recommended.
来自白种人和黑人人群的近期报告表明儿童肾病综合征的类固醇反应性发生了变化。因此，本研究旨在确定一组患肾病综合征黑人儿童的特征和类固醇敏感性模式。回顾了2008年1月至2013年4月间接受肾病综合征治疗的儿童记录。分析了包括年龄、治疗反应和肾脏组织学等细节。共有108名儿童（中位年龄：5.9岁，高峰年龄：1 - 2岁），其中90.2%患有特发性肾病综合征。特发性肾病综合征儿童的类固醇敏感性为82.8%，但总体为75.9%。缓解的中位时间为7天。与耐药患者相比，类固醇敏感患者的中位年龄显著更低。耐药病例中主要的组织学发现是局灶节段性肾小球硬化（53.3%）。未诊断出三日疟肾病或乙型肝炎病毒肾病病例。总体死亡率为6.5%。总之，报告显示一组黑人儿童中类固醇敏感性异常高。这可能归因于我们研究队列中较低的年龄结构以及其他一些儿童疾病可能变化的流行病学情况。因此，建议对儿童肾病综合征的流行病学进行监测并在实践中做出相应调整。
