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Abstract: FR-PO1122

Variability in Treatment of Childhood Nephrotic Syndrome in Africa

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Esezobor, Chris, College of Medicine University of Lagos, Lagos, Nigeria
  • Noone, Damien Gerard, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Gbadegesin, Rasheed A., Duke University Medical Center, Durham, North Carolina, United States
  • Parekh, Rulan S., The Hospital For Sick Children, Toronto, Ontario, Canada

Group or Team Name

  • H3 Africa Kidney Disease Research Network
Background

Idiopathic nephrotic syndrome (NS) is the most common glomerular disease in African children. Clinical practice is guided based on limited resources for diagnosis and management of NS in most of the African continent. We aimed to determine variability in treatment of NS in Africa to develop a consensus guideline for the treatment of NS in middle and low-income countries.

Methods

Using the KDIGO guidelines as the basis for the management of NS, we developed a survey to assess current practices in 6 Sub-Saharan African countries. Approximately 50 adult and pediatric nephrologists from West, East and South Africa, in the H3 Africa Kidney Disease Research Network, were invited to complete the survey. Responses on treatment choices, duration of therapy, management of relapses and management of steroid resistant NS (SRNS) were collected.

Results

30 nephrologists (20 pediatric, 4 adult and 6 both) from 19 hospital centers located in Nigeria, Ghana, Cameroon, Uganda, Tanzania and South Africa, completed the survey. Variability in treatment choices and practice were observed when compared with international guidelines. The definition of child varies by country, ranging from ages 12-18 (median 17), thus adult nephrologists also manage idiopathic NS. The initial treatment of steroid sensitive NS, and the definition and management of relapses varied widely across the respondents (Figure). Remission was defined by negative urinary protein ranging from 3-7 days (median 3). Only about 50% prescribed calcineurin inhibitors for children with SRNS.

Conclusion

Management of NS varied widely across and within countries in Africa, thus the importance of a consensus guideline tailored to an African context. Adult nephrologists often manage adolescents and youth, thus need to be aware of the pediatric management. Standardizing practice across the continent will provide an opportunity to understand the burden and long-term outcomes of NS.

Variability in treatment of NS

Funding

  • NIDDK Support