Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria.
Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
PLoS One. 2020 Sep 21;15(9):e0239300. doi: 10.1371/journal.pone.0239300. eCollection 2020.
Recent reports from small studies in West Africa suggest that Black children may have high rate of steroid sensitivity nephrotic syndrome (SSNS) contrary to long held knowledge. Herein, we determined the proportion of children with idiopathic nephrotic syndrome (INS) who achieved complete remission with steroid therapy and identified factors associated with complete remission.
We reviewed the medical records of 241 children with INS in two centres in Lagos from 2010 to 2019. We extracted demographic data, clinical features, laboratory values at the time of diagnosis, and receipt and response to steroids and other immunosuppressants.
The median (interquartile range) age at diagnosis of INS was 5.1 (3.0-8.7) years and boys were 60.2% of the study population. Children with SSNS made up 85.9% (n = 207) of the study cohort. Among those aged 0-5 years, 92.6%were SSNS compared with 69.2% in those aged 11-17 years at the time of diagnosis. In addition, the proportion of children with SSNS increased from 73.8% between year 2010 and 2012 to 88.4% afterwards. Also, children with SSNS had lower serum creatinine (0.44 vs 0.70; p<0.001) and higher estimated glomerular filtration rate (101 vs 74.3 ml/min/1.73 m2; p = 0.008) at the time of diagnosis than those with steroid resistant nephrotic syndrome (SRNS).
Among Black children in Lagos, the proportion with SSNS is comparable to proportions described in children of Asian and European descent. Furthermore, children with SSNS had lower serum creatinine and higher glomerular filtration rate than those with SRNS.
最近来自西非的小型研究报告表明，与长期以来的认识相反，黑人儿童可能患有高比例的类固醇敏感性肾病综合征（SSNS）。在此，我们确定了接受类固醇治疗后达到完全缓解的特发性肾病综合征（INS）患儿的比例，并确定了与完全缓解相关的因素。
我们回顾了 2010 年至 2019 年在拉各斯的两个中心的 241 例 INS 患儿的病历。我们提取了人口统计学数据、临床特征、诊断时的实验室值，以及接受类固醇和其他免疫抑制剂治疗的情况及其反应。
INS 的中位（四分位间距）诊断年龄为 5.1（3.0-8.7）岁，男孩占研究人群的 60.2%。SSNS 患儿占研究队列的 85.9%（n=207）。在 0-5 岁的患儿中，92.6%为 SSNS，而在 11-17 岁的患儿中，这一比例为 69.2%。此外，SSNS 患儿的比例从 2010 年至 2012 年的 73.8%增加到此后的 88.4%。此外，与类固醇抵抗性肾病综合征（SRNS）患儿相比，SSNS 患儿的血清肌酐（0.44 与 0.70；p<0.001）较低，肾小球滤过率（101 与 74.3 ml/min/1.73 m2；p=0.008）较高。
在拉各斯的黑人儿童中，SSNS 的比例与亚洲和欧洲裔儿童的比例相当。此外，SSNS 患儿的血清肌酐较低，肾小球滤过率较高，而 SRNS 患儿则较低。
