Nephrotic Syndrome in Children – Studies from South Africa

Abstract

Worldwide research has shown that racial differences occur with regard to the histological subtypes, response to treatment and outcome of idiopathic nephrotic syndrome (INS) in children (Bhimma et al. 2006:1847; Bhimma, R. 2009:15; Ingulli T Filler et al. 2003 :1107; Srivastava et al. 1991:13). Studies reporting the outcome of INS associated with FSGS are variable, which is not surprising, as differences in the population mix, aetiology, pathogenesis and duration of disease are often not taken into consideration. This begs the question whether the recommendation of the International Study of Kidney Disease in Children for the management of INS should still be adhered to. Or should it be revised taking into consideration different racial groups? On the other hand, in the light of the rising incidence of FSGS, it may be prudent to withdraw the recommendation. Paediatric nephrologists from developing countries, and specifically Africa, need to formulate guidelines specific to their patients with INS. To this end, relevant clinical characteristics such as the antenatal and family history, birth weight, feeding and nutrition, growth and onset of disease should be documented and analysed in their reports. Low birth weight (LBW) which has been shown to be associated with decreased glomerular endowment (Manalich et al. 2007:770, Vehaskari , VM. 2007:490) and subsequent increased risk for the development of chronic kidney disease (CKD), is a case in point, since it is more common in impoverished population groups living in Africa. However, most publications describing the influence of LBW on CKD come from developed countries. (Teeninga et al. 2008:1615)