The clinical characteristics and histological subtypes of nephrotic syndrome in paediatric patients at the University Teaching Hospital , Lusaka, Zambia

Abstract

BACKGROUND: Nephrotic syndrome (NS) and glomerulonephritis are the commonest glomerular diseases seen at the University Teaching Hospital (UTH), Lusaka, in the department of Paediatrics and Child Health. [1] Nephrotic syndrome commonly presents with hypoalbuminaemia, oedema and hyperlipidaemia. Little is known about the clinical characteristics and histological patterns Zambian children. This study investigated the clinical characteristics and histological subtypes of NS patients presenting to the Department of Paediatrics and Child Health, at the University Teaching Hospital, in Lusaka, Zambia. METHODOLOGY: A non-randomized prospective study of consecutive cases of Zambian children with nephrotic syndrome was conducted between August 2014 and March 2015. RESULTS: Thirteen participants were enrolled in this study. Median NS onset age was 9.25 years (2.0-15.0). Male: female ratio was 1:1.16. Out of the 13 participants, 10 had atypical features such as haematuria and hypertension in addition to the classic features of NS. The histopathologic lesions were MCD (4/13 participants), FSGS (4/13 participants) and immune complex mediated Membranous Nephropathy (1/13 participants). Histology reports for the other 4 participants were inconclusive. Two patients with FSGS had the perihilar variant whole the other two had the not otherwise specified (NOS) variant. Two participants attained remission during the period of the study and they were both early responders with one having MCD and the other having the perihilar variant of FSGS. CONCLUSION: Most of our participants had atypical presentation (76.9%) i.e. presented with haematuria or hypertension, or both, in addition to the classic clinical characteristics. The predominant lesions were non-MCD with FSGS accounting for 4 and immune complex induced Membranous Nephropathy for 1 out of the 9 patients with biopsy reports. Out of the 13 children, only 2 attained remission during the 7 month period showing that MCD in our participants did not respond well to steroid therapy.