Welegerima Yainu, Feyissa Mamo, Nedi Teshome
Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Int J Nephrol Renovasc Dis. 2021 May 24;14:149-156. doi: 10.2147/IJNRD.S310567. eCollection 2021.
Nephrotic syndrome is a common glomerular disease in children with a relapsing course that leads to complications and steroid-related toxicities. In Ethiopia, data on the outcomes of steroid therapy in pediatric nephrotic syndrome patients are limited.
The aim of the study was to assess the treatment outcomes of pediatric nephrotic syndrome patients in Ayder Specialized Comprehensive and Mekelle General Hospitals.
A retrospective study was conducted among children treated for nephrotic syndrome from 2010 to 2017 in Ayder Comprehensive Specialized and Mekelle General Hospitals. Univariate and multivariate logic regression analyses were performed to identify determinants of treatment outcome with a p-value <0.05 considered statistically significant.
A total of 159 pediatric patients treated for nephrotic syndrome in both hospitals were included in this study. The mean age of participants at the initial diagnosis was 5.21 ± 2.66 years. Most of the patients 150 (94.3%) achieved remission within 4 weeks of steroid therapy. Among initial responders, the majority of the patients 117 (78%) encountered relapses of which 65 (40.9%) were developed frequent relapse/steroid-dependent nephrotic syndrome. Also, the majority of patients 102 (64.5%) encountered steroid-related toxicities. The predictors of frequent relapse/steroid-dependent nephrotic syndrome were age of ≤6 years (AOR=3.16; p=0.00), hematuria (AOR=6.74; p=0.00), infection (AOR=3.28; p=0.01), acute renal failure (AOR=6.09; p=0.01), serum albumin below 1.5g/dl (8.38, p=0.01) and lack of remission within 2 weeks (AOR=3.69; p=0.00).
Most of the pediatric NS patients treated in ACSH and MGH have achieved remission with initial to steroid therapy. However, there was a higher relapse rate and steroid-related toxicities among pediatric NS patients who achieved remission. Early age at diagnosis, hematuria, reduced GFR, infection, and remission time were the independent predictors of the frequent relapsing/steroid-dependent nephrotic disease course.
肾病综合征是儿童常见的肾小球疾病，病程易复发，可导致并发症及类固醇相关毒性反应。在埃塞俄比亚，关于小儿肾病综合征患者类固醇治疗结局的数据有限。
本研究旨在评估阿伊德专科医院和默克莱综合医院小儿肾病综合征患者的治疗结局。
对2010年至2017年在阿伊德综合专科医院和默克莱综合医院接受肾病综合征治疗的儿童进行回顾性研究。进行单因素和多因素逻辑回归分析以确定治疗结局的决定因素，p值<0.05被认为具有统计学意义。
本研究纳入了两家医院共159例接受肾病综合征治疗的儿科患者。初次诊断时参与者的平均年龄为5.21±2.66岁。大多数患者150例（94.3%）在类固醇治疗4周内实现缓解。在初始缓解者中，大多数患者117例（78%）复发，其中65例（40.9%）发展为频繁复发/类固醇依赖型肾病综合征。此外，大多数患者102例（64.5%）出现类固醇相关毒性反应。频繁复发/类固醇依赖型肾病综合征的预测因素为年龄≤6岁（比值比=3.16；p=0.00）、血尿（比值比=6.74；p=0.00）、感染（比值比=3.28；p=0.01）、急性肾衰竭（比值比=6.09；p=0.01）、血清白蛋白低于1.5g/dl（8.38，p=0.01）以及2周内未缓解（比值比=3.69；p=0.00）。
在阿伊德综合专科医院和默克莱综合医院接受治疗的大多数小儿肾病综合征患者在初始类固醇治疗后实现了缓解。然而，实现缓解的小儿肾病综合征患者中复发率和类固醇相关毒性反应较高。诊断时年龄小、血尿、肾小球滤过率降低、感染和缓解时间是频繁复发/类固醇依赖型肾病病程的独立预测因素。
