PREDICTORS OF RESISTANCE TO STEROIDS IN PEDIATRIC NEPHROTIC SYNDROME AT A TERTIARY HOSPITAL, ADDIS ABABA
Keywords:nephrotic syndrome, steroid resistance, relapse, children, Ethiopia
Background: Nephrotic Syndrome is a major health problem worldwide and an important chronic renal disease in children. It is the second most common renal disease in pediatric prac-tice in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. No studies done that show prevalence and predictors of resistance to steroids in our setting.
Objective: The aim of this study was to determine prevalence and factors predictive of re-sistance to steroids in pediatric nephrotic syndrome
Patients and Methods: A cross-sectional retrospective review of medical documents of children 1-15 years of age with the diagnosis of nephrotic syndrome was done from September 2012 to January 2019 who were on follow up at Pediatric Renal Clinic of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
Result: A total of 85 children with the diagnosis of nephrotic syndrome were identified and their mean age was 6.2 (+3 years). Males were 59/85 (69.4%) with a male to female ratio of 2.3:1. Sixty-nine of 85 (81.2%) children responded to steroids, but 16/85 (18.8%) were steroid resistant. Thirteen of 85 (15.3%) children were steroid dependent. Hematuria was detected in 42/85 (49.4%). Twenty-nine out of 85 (34.1%) and 13/85 (15.3%) children had microscopic and gross hematuria, respectively. On bivariate analysis children with gross hematuria, decreased urine output, hypertension and elevated creatinine were more likely to be steroid resistant (p < 0.001). On multivariate analysis gross hematuria and decreased urine output were independent risk factors for resistance to steroids.
Conclusion: Predictors of steroid resistance are comparable with other studies. These findings are important for early decision about the requirement for more aggressive immunosuppressive treatment.