Summary
Nephrotic syndrome is a common childhood glomerular disease that is associated with
massive proteinuria and edema. Children with nephrotic syndrome are at risk of chronic
kidney disease, disease-related complications, and treatment-related complications.
Patients with frequently relapsing disease or steroid toxicity may require newer immunosuppressive
medications. However, access to these medications is limited in many African countries
owing to prohibitive cost, the need for frequent therapeutic drug monitoring, and
a lack of appropriate facilities. This narrative review examines the epidemiology
of childhood nephrotic syndrome in Africa, including trends in treatment and patient
outcomes. In most of North Africa, as well as among White and Indian populations in
South Africa, the epidemiology and treatment of childhood nephrotic syndrome closely
resembles that of European and North American populations. Historically, secondary
causes of nephrotic syndrome (eg, quartan malaria nephropathy and hepatitis B–associated
nephropathy) were predominant among Blacks in Africa. Over time, the proportion of
secondary cases has decreased, along with rates of steroid resistance. However, focal
segmental glomerulosclerosis increasingly has been reported among patients with steroid
resistance. There is a need for consensus guidelines for the management of childhood
nephrotic syndrome in Africa. Furthermore, establishing an African nephrotic syndrome
registry could facilitate monitoring of disease and treatment trends, and provide
opportunities for advocacy and research to improve patient outcomes.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Seminars in NephrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Management of idiopathic childhood nephrotic syndrome in sub-Saharan Africa: Ibadan consensus statement.Kidney Int. 2021; 99: 59-67
- IPNA clinical practice recommendations for the diagnosis and management of children with steroid-resistant nephrotic syndrome.Pediatr Nephrol. 2020; 35: 1529-1561
- Paediatric end-stage renal disease in a tertiary hospital in South West Nigeria.BMC Nephrol. 2014; 15: 25
- Ethnic differences in childhood nephrotic syndrome.Front Pediatr. 2016; 4: 39
- Ethnic differences in incidence and outcomes of childhood nephrotic syndrome.Clin J Am Soc Nephrol. 2016; 11: 1760-1768
- High incidence of focal segmental glomerulosclerosis in nephrotic syndrome of childhood.Pediatr Nephrol. 1999;; 13: 13-18
- Time trends and ethnic patterns of childhood nephrotic syndrome in Yorkshire, UK.Pediatr Nephrol. 2001; 16: 1040-1044
- Changing patterns in the histopathology of idiopathic nephrotic syndrome in children.Kidney Int. 1999; 55: 1885-1890
- Childhood nephrotic syndrome in tropical Africa: then and now.Paediatr Int Child Health. 2017; 37: 259-268
- Trends in the epidemiology of childhood nephrotic syndrome in Africa: a systematic review.Glob Epidemiol. 2021; 3: 100061
- The initial response to corticosteroid therapy in childhood nephrotic syndrome in Cote d’Ivoire.Afr J Paediatr Nephrol. 2014; 1: 57-61
- Changing epidemiology of nephrotic syndrome in Nigerian children: a cross-sectional study.PLoS One. 2020; 15e0239300
- Paediatric nephrology in Africa.Curr Pediatr Rep. 2021; 9: 134-141
The World Bank. World Bank country and lending groups. Country classification 2022. Accessed September 17, 2022. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
- Nephrosis in Nigerian children. Role of Plasmodium malariae, and effect of antimalarial treatment.Br Med J. 1963; 2: 27-31
- The nephrotic syndrome and other renal diseases in children in Western Nigeria.East Afr Med J. 1963; 40: 186-201
- Epidemiological and evolving aspects of nephrotic syndrome in children aged 0-15 years in Tanguiéta District Hospital (Benin).Int J Nephrol Kidney Fail. 2020; 6: 1-4
- Response to corticosteroid treatment in paediatric nephrotic syndrome: a retrospective review from Mozambique.South Afr J Child Health. 2021; 15: 38-43
- Collaborative clinicopathological study in Nigerian children.Lancet. 1972; 1: 1143-1149
- Differential protein clearances and response to treatment in Nigerian nephrotic children.Arch Dis Child. 1976; 51: 691-696
- A controlled trial of cyclophosphamide and azathioprine in Nigerian children with the nephrotic syndrome and poorly selective proteinuria.Arch Dis Child. 1979; 54: 204-207
- Selectivity of proteinuria and response to prednisolone or immunosuppressive drugs in children with malarial nephrosis.Lancet. 1970; 1: 644-648
- “Topical nephropathy” and “tropical extramembranous glomerulonephritis” of unknown aetiology in Senegal.Br Med J. 1975; 1: 541-546
- The nephrotic syndrome in Ghana: clinical and pathological aspects.Q J Med. 1981; 50: 297-306
- Clinicopathological features of childhood nephrotic syndrome in northern Nigeria.Q J Med. 1990;; 75: 563-576
- Childhood renal disorders in Nigeria.Pediatr Nephrol. 1990; 4: 88-93
- Renal disorders in children: a Nigerian study.Pediatr Nephrol. 1994; 8: 383-386
- Epidemiology and clinicopathologic characteristics of childhood nephrotic syndrome in Benin-City, Nigeria.J Pak Med Assoc. 1998; 48: 235-238
- Childhood nephrotic syndrome in Enugu, Nigeria.West Afr J Med. 2000; 19: 137-141
- The predominance of membranoproliferative glomerulonephritis in childhood nephrotic syndrome in Ibadan, Nigeria.West Afr J Med. 1999; 18: 203-206
- Nephrotic syndrome in African children: lack of evidence for 'tropical nephrotic syndrome'?.Nephrol Dial Transplant. 2006; 21: 672-676
- Demographic, clinical and therapeutic characteristics of children aged 0-15 years with nephrotic syndrome: a retrospective study of the Komfo Anokye Teaching Hospital, Kumasi, Ghana.Asian J Med Health. 2017; 5: 1-9
- [Idiopathic nephrotic syndrome (INS) in children in Dakar: about 40 cases].Pan Afr Med J. 2017; 26: 161
- [Nephrotic syndrome in children at the Dakar University Hospital].Arch Pediatr. 2016; 23: 653-654
- [Use of new protocols in the management of nephrotic syndrome in black African children. Experience of the University Hospital Center of Yopougon (Abidjan, Cote-d'Ivoire)].Arch Pediatr. 2003; 10: 352-353
- Reversed clinical and morphologic characteristics of idiopathic childhood nephrotic syndrome.Int J Nephrol Urol. 2010; 2: 200-211
- Childhood nephrotic syndrome as seen at the Federal Medical Centre, Umuahia, Nigeria.Afr J Paediatr Nephrol. 2014; 1: 62-66
- The pattern and outcomes of childhood renal diseases at University of Abuja Teaching Hospital, Abuja, Nigeria: a 4 year retrospective review.Niger Postgrad Med J. 2019; 26: 53
- Childhood nephrotic syndrome at the University of Abuja Teaching Hospital, Abuja, Nigeria: a preliminary report supports high steroid responsiveness.Sudan J Paediatr. 2019; 19: 126-139
- Childhood nephrotic syndrome: change in pattern and response to steroids.J Natl Med Assoc. 2006; 98: 1977-1981
- Trends in the histopathology of childhood nephrotic syndrome in Ibadan Nigeria: preponderance of idiopathic focal segmental glomerulosclerosis.BMC Nephrol. 2015; 16: 213
- High steroid sensitivity among children with nephrotic syndrome in Southwestern Nigeria.Int J Nephrol. 2014; 2014350640
- Cyclosporine in the treatment of childhood idiopathic steroid resistant nephrotic syndrome: a single centre experience in Nigeria.Pan Afr Med J. 2016; 25: 258
- Pattern of renal diseases in children in midwestern zone of Nigeria.Saudi J Kidney Dis Transplant. 2003; 14: 539
- The burden and outcome of pediatric renal admissions at the federal teaching hospital Abakaliki: a 3-year review (2011–2013).Ann Med Health Sci Res. 2016; 6: 243-250
- Gross motor developmental delay in human immunodeficiency virus-infected children under 2 years of age.Ann Afr Med. 2019; 18: 185-190
- Biopsy-proven renal disease in Ile-Ife, Nigeria: a histopathologic review.Indian J Nephrol. 2016; 26: 16-22
- Frequency of relapse among Nigerian children with steroid-sensitive nephrotic syndrome.Niger J Clin Pract. 2016; 19: 254-258
- Nephrotic syndrome among children in Kano: a clinicopathological study.Niger J Clin Pract. 2014; 17: 370-374
- Childhood nephrotic syndrome in Southeast Nigeria: the old story or any change in pattern?.Indian J Child Health. 2020; 7: 251-254
- Quartan malaria-associated childhood nephrotic syndrome: now a rare clinical entity in malaria endemic Nigeria.Nephrol Dial Transplant. 2010; 25: 794-801
- SUN-456 monogenic nephrotic syndrome in nigerian children.Kidney Int Rep. 2020; 5: S384
- Childhood idiopathic steroid resistant nephrotic syndrome in Southwestern Nigeria.Saudi J Kidney Dis Transpl. 2010; 21: 979-990
- Remission patterns and renal function status from the use of cyclosporine in children with idiopathic steroid-resistant nephrotic syndrome at a Nigerian tertiary health-facility.Afr J Paediatr Nephrol. 2018; 5: 77-83
- Pattern of renal diseases in children admitted into the paediatric ward of Federal Medical Center, Asaba.Afr J Nephrol. 2013; 1: 6-9
- Primary nephrotic syndrome in Arab children.Arch Dis Childhood. 1984; 59: 253-255
- A descriptive retrospective study on children with newly diagnosed nephrotic syndrome presented to Tripoli Children Hospital during the period between Jan. to Dec. 2014.Libyan Int Med Univ J. 2016; 1: 45-56
- [Idiopathic nephrotic syndrome in children: report of 57 cases].Tunis Med. 2003; 81: 702-708
- Pattern and outcome of renal diseases in hospitalized children in Khartoum State, Sudan.Sudan J Paediatr. 2012; 12: 52
- Epidemiology of primary nephrotic syndrome in Egyptian children.J Nephrol. 2012; 25: 732-737
- [Idiopathic steroid-resistant nephrotic syndrome in child : study of 20 cases].Tunis Med. 2011; 89: 522-528
- Histopathological spectrum of childhood idiopathic steroid-resistant nephrotic syndrome in Tunisia.Tunis Med. 2011; 89: 258-261
- Results of renal biopsy in children with nephrotic syndrome at Tripoli Children Hospital.Misurata Medical Sciences Journal. 2015; 2: 114-116
- Histological patterns of idiopathic steroid resistant nephrotic syndrome in Egyptian children: a single centre study.J Nephropathol. 2013; 2: 53
- Childhood idiopathic steroid-resistant nephrotic syndrome at a single center in Khartoum.Saudi J Kidney Dis Transpl. 2017; 28: 851-859
- HLA-DRB1* alleles in Egyptian children with post-streptococcal acute glomerulonephritis.Pediatr Nephrol. 2007; 22: 376-379
- Indications and results of renal biopsy in children: a single-center experience from Morocco.Saudi J Kidney Dis Transpl. 2015; 26: 810-815
- HLA-DQB1 and DRB1 alleles in Egyptian children with steroid-sensitive nephrotic syndrome.Pediatr Nephrol. 1998; 12: 234-237
- HLA alleles in frequently relapsing steroid-dependent and -resistant nephrotic syndrome in Egyptian children.Pediatr Nephrol. 2005; 20: 159-162
- Childhood steroid-sensitive nephrotic syndrome: characteristics and predictors of relapses (a study at a single center in Khartoum).Sudan J Med Sci. 2018; 13: 133-143
- Cyclophosphamide versus cyclosporine in children with frequent-relapsing and steroid-dependent nephrotic syndrome in Khartoum State, Sudan.Khartoum Med J. 2017; 10: 1402-1410
- Co-administration of cyclosporine and ketoconazole in children with minimal change nephrotic syndrome.Nephron Clin Pract. 2005; 100: c27-c32
- Impact of the cyclosporine-ketoconazole interaction in children with steroid-dependent idiopathic nephrotic syndrome.Eur J Clin Pharmacol. 2006; 62: 3-8
- Mycophenolate mofetil in treatment of childhood steroid-dependent nephrotic syndrome.Tunis Med. 2016; 94: 221-225
- Mycophenolate mofetil in treatment of childhood steroid-resistant nephrotic syndrome.J Nephrol. 2011; 24: 203-207
- The challenges of caring for children with nephrotic syndrome in a tertiary institution in the Democratic Republic of Congo.Acta Paediatr. 2014; 103: e365-e369
- Malaria prophylaxis and immunosuppressant therapy in management of nephrotic syndrome associated with quartan malaria.Arch Dis Child. 1968; 43: 598-600
- Histological features of the nephrotic syndrome associated with quartan malaria.J Clin Pathol. 1967; 20: 117-123
- The nephrotic syndrome in Uganda and its association with quartan malaria.Q J Med. 1967; 36: 393-408
- Proteinuric renal disease in children in South-Western Uganda.QJM. 2003;; 96: 382-384
- Pattern and outcome of renal diseases in hospitalized children in Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia.Ethiop Med J. 2016; 54: 117-123
- Treatment outcomes of pediatric nephrotic syndrome patients treated in Ayder Comprehensive Specialized and Mekelle General Hospitals, Ethiopia.Int J Nephrol Renovasc Dis. 2021; 14: 149-156
- Steroid response pattern among children with nephrotic syndrome in Northern Ethiopia.Nephrourol Mon. 2020; 12e106995
- Time to relapse and its predictors among children with nephrotic syndrome in comprehensive specialized hospitals, Tigray, Ethiopia, 2019.Int J Pediatr. 2020; 20208818953
- Nephrotic syndrome in South African children: changing perspectives in the new millennium.Kidney Int Rep. 2019; 4: 522-534
- Clinico-pathological features of the nephrotic syndrome in South African children.Q J Med. 1979; 48: 77-91
- Nephrotic syndrome in South African children: changing perspectives over 20 years.Pediatr Nephrol. 1997; 11: 429-434
- Membranous glomerulonephropathy in childhood.S Afr Med J. 1987; 72: 184-187
- Idiopathic nephrotic syndrome in South African children.Afr Health Sci. 2017; 17: 1130-1136
- Steroid-resistant nephrotic syndrome: the influence of race on cyclophosphamide sensitivity.Pediatr Nephrol. 2006; 21: 1847-1853
- NPHS2 V260E is a frequent cause of steroid-resistant nephrotic syndrome in Black South African Children.Kidney Int Rep. 2018; 3: 1354-1362
- Management of steroid-resistant focal segmental glomerulosclerosis in children using tacrolimus.Am J Nephrol. 2006; 26: 544-551
- Primary nephrotic syndrome in the new millennium in KwaZulu-Natal, South Africa.S Afr Med J. 2020; 110: 678-685
- Proteinuric kidney disease in children at Queen Elizabeth Central Hospital, Malawi.BMC Nephrol. 2018; 19: 21
- Increased steroid responsiveness of young children with nephrotic syndrome in Nigeria.Ann Trop Paediatr. 2005; 25: 199-203
- Pediatric idiopathic steroid-sensitive nephrotic syndrome: diagnosis and therapy—short version of the updated German best practice guideline (S2e)—AWMF register no. 166-001, 6/2020.Pediatr Nephrol. 2021; 36: 2971-2985
- KDIGO 2021 clinical practice guideline for the management of glomerular diseases.Kidney Int. 2021; 100: S1-S276
- Clinical practice guidelines for nephrotic syndrome: consensus is emerging.Pediatr Nephrol. 2022; 37: 2975-2984
- Steroid sensitive nephrotic syndrome: revised guidelines.Indian Pediatr. 2021; 58: 461-481
- Non-corticosteroid immunosuppressive medications for steroid-sensitive nephrotic syndrome in children.Cochrane Database Syst Rev. 2013; 10CD002290
- A randomized clinical trial indicates that levamisole increases the time to relapse in children with steroid-sensitive idiopathic nephrotic syndrome.Kidney Int. 2018; 93: 510-518
- A meta-analysis of cytotoxic treatment for frequently relapsing nephrotic syndrome in children.Pediatr Nephrol. 2001; 16: 271-282
- Focal segmental glomerulosclerosis in children.Tunis Med. 2016; 94: 356-359
- Interventions for idiopathic steroid-resistant nephrotic syndrome in children.Cochrane Database Syst Rev. 2016; 10CD003594
- Rituximab treatment for severe steroid- or cyclosporine-dependent nephrotic syndrome: a multicentric series of 22 cases.Pediatr Nephrol. 2008; 23: 1269-1279
Article info
Publication history
Published online: March 10, 2023
Footnotes
Financial disclosure and conflict of interest statements: none.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
