Quality of Life in Children with Minimal Change Nephrotic Syndrome

Abstract

Introduction: Nephrotic syndrome (NS) in children is a common, yet challenging, relapsing, and remitting renal disorder and exhibits a heterogeneous clinical phenotype ranging from a single episode, infrequently relapsing, frequently relapsing to steroid-resistant disease. Although 80% of these children are corticosteroid responsive, nearly half of them demonstrate a frequently relapsing or steroid-dependent course, often resulting in multiple complications, hospitalizations, or even chronic renal failure. Objective: To assess the quality of life in patients with minimal change nephrotic syndrome. Methods: This cross-sectional, comparative, questionnaire-based study was conducted in Dhaka Shishu Hospital, Dhaka, Bangladesh July to December 2022. The cases included children with MCD, attending the pediatric nephrology unit and outpatient clinic of nephrology unit. 100 children were selected then they were randomly subdivided into 2 groups, group 1 included 50 known cases of MCD aged 2–18 years and group 2 included 50 age matched children attending the general pediatric outpatient clinic and other pediatric subspecialty clinics. We distributed two questionnaires to 32 outpatients with MCNS. We also used the Self-Care Behavior Scale for patients with chronic kidney disease (CKD), which consists of 31 questions with 4 subscales. Results: Total of one hundred studied nephrotic patients with MCD and an equal number of controls with other chronic diseases aged 2.2–15 year and 3.5–13 years, respectively, were included in the study. Table 1 illustrated the demographic details of the studied cases and controls. Among children with MCD, 32% had first attack or infrequently relapsing variant while 68% had difficult to treat clinical phenotypes (frequently relapsing, steroid– dependent and steroid-resistant varieties). The SF-36v2 social functioning subscale was most impaired and bodily pain was least affected in patients with MCNS. The self-care subscales of information/communication and positive behavior had positive correlations with the QOL subscales of mental health (𝑃 < 0.05) and vitality (p<0.05). The correlation between social functioning and information/communication was close to significant (𝑃 = 0.051). Conclusion: In conclusion, our findings suggest that patients with MCNS have lower QOL based on low social functioning and that QOL is related to the positive behavior and thoughts of the patients. These results also show that healthcare professionals should be conscious of the QOL of children with MCNS.