Adult nephrotic syndrome in the Niger delta sub region: a single centre study at the university of Port Harcourt teaching hospital
Keywords:Adult nephrotic syndrome, Niger delta, Nigeria
Background: Adult nephrotic syndrome is a common cause of chronic kidney disease globally and in Sub-Saharan Africa. In Nigeria there are only few studies on adult nephrotic syndrome, mostly from the south-western Nigeria and rarely from the Niger delta sub-region of Nigeria. This study aims at contributing to the National data on adult nephrotic syndrome, from the perspective of the Niger delta sub-region.
Methods: Retrospective analysis of five-year clinical data (January 2007 to December 2011) of adult nephrotic syndrome patients in the University of Port Harcourt teaching hospital was conducted.
Results: Forty-four patients, representing 1% of medical admissions and 7.3% of adult renal cases were seen during the period, with mean age of 27.7±8.5 years. There were 32 males (72.7%). Mean duration of illness was 25.3±30.3months. Peak age group was the 20-29 year age group, accounting for 52.3% of cases. Hypertension was seen in 45.5%. Mean e-GFR was 73.5±33.8 ml/min/1.73m2 with CKD 1-3 constituting 93.2% of cases. Mean 24-hour urinary protein excretion was 13.6±8.4 grams/day. Protein excretion >10grams/day was observed in 65.8% of the patients. Mean total serum protein, albumin and total cholesterol were 51.4±11.7g/dl, 22.5±9.9 g/dl and 8.1±3.0 mmol/L, respectively. Anemia was common (68%) and histology showed MCGN (52.6%), MCD (21.1%), membranous (15.8%) and FSGS (10.5%). Though response to therapy was generally poor, immunosuppressive therapy showed better outcomes.
Conclusions: The prevalence and pattern of adult nephrotic syndrome in the Niger delta sub-region is similar to that in other parts of Nigeria. It is predominantly a disease of young adult males with high prevalence of hypertension, and poor histologic categories.
Vivante A, Hildebrandt F. Exploring the genetic basis of early-onset chronic kidney disease. Nat Rev Nephrol. 2016;12:133-46.
Cameron JS. Glomerulonephritis. In: Marsh F(ed) Post Graduate Nephrology. London: William Heinmann Medical books Ltd; 1985.
Asinobi AO, Gbadegesin RA, Adeyemo AA, Akang EE, Arowolo FA, Abiola OA, et al. Predominance of membranoproliferative glomerulonephritis in childhood nephrotic syndrome in Ibadan, Nigeria. West Afr J Med. 1999;18:203‑6.
Abdelraheem MB, Ali ETM, Mohamed RM, Hassan EG, Abdalla OA, Mekki SO, et al. Pattern of glomerular diseases in Sudanese children: A clinico-pathological study. Saudi J Kidney Dis Transpl. 2010;21:778-83.
Chijioke A, Adeniyi AB. Clinicopathologic study of Adult Nephrotic Syndrome in Ilorin, Nigeria. Nigerian Medical Practitioner. 2003;43(2):28-32.
Adekoya AO, Aderibigbe A, Awubosoyi JO, Babafemi JO. Socio-economic status of patients with nephrotic syndrome in Ilorin. Paper presented at: 20th Congress and Scientific Meeting of the Nigerian Association of Nephrology, NANCONF. 2008:22-3.
Arije A, Kuti M, Salako BL, Kadiri S. Renal diseases in a tertiary hospital: a one year hospital-based data entry analysis. Paper presented at: 18th Congress and Scientific Meeting of the Nigerian Association of Nephrology, NANCONF 2006; 2006:4.
Wokoma FS, Okafor UH. Characteristics of haemodialysis patients at the University of Port Harcourt teaching hospital during the first year of operation. Trop J Neph. 2008;(3):95-101.
(NPC) National Population Commission. The Nigeria Population Census; 2006. Available at: http://www.population.gov.ng/index.php?option=com_content&view=artide&id=89 Accessed 12 December 2011.
Gupter KL, Zulfikar J. Nephrotic syndrome. In: Kalra OP (ed). Renal Disease-Prevention and Management: A physician perspective. Assoc Physicians India. 2008:38-44.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16:31-41.
National Kidney Foundation (NKF/DOQI. Clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kidney Dis. 2002;39(suppl. 1):s1-s266.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003 Dec 1;42(6):1206-52.
Anochie I, Eke F, Okpere A. Childhood nephrotic syndrome: Change in pattern and response to steroids. J Natl Med Assoc. 2006;98:1977‑81.
Olowu WA, Adelusola KA, Adefehinti O. Reversed Clinical and Morphologic Characteristics of Idiopathic Childhood Nephrotic Syndrome. Int J Nephrol Urol. 2010;2(1):200-11.
Chih-Kang C, Reiko I. Glomerular diseases: Genetic causes and future therapeutics. Nature Review Nephrol. 2010;6:539-54.
Welsh IG, Saleem MA. The podocyte cytoskeleton-key to functioning glomerulus in health and disease. Nat Rev Nephrol. 2012;8:14-21.
Hall JE, Heneger JR, Dwyer TM, Liu J, da-Silva AA, Kuo JJ, et al. Obesity a major cause of chronic kidney disease? Adv Ren Replace Ther. 2004;11(1):41-54.
Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ. Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Inter. 2008 Jan 1;73(1):19-33.
Barr RD, Rees PH, Cordy PE, Kungu A, Woodger BA, Cameron HM. Nephrotic Syndrome in Adult Africans in Nairobi. Brit Med J.1972;2:131-4.
Kwaifa SI, Samaila MOA, Saad A, Bappa AU, Ibrahim A, Bosan IB, et al. Histopathologic Characteristics of Patients Presenting with Nephrotic Syndrome in the Guinea Savannah Belt of Nigeria (NANCONF 2010, ABS-OR-1017). Trop J Neph. 2010;5(1):50-1.
Simmon S, Neil A, Alistair C, John C. The Nephrotic syndrome. In: Oxford Handbook of Nephrology and hypertension. Oxford University Press New York; 2011:386.
Hendrickse RG, Glasgow EF, Adeniyi A, White RHR, Edington GM, Houba V. Quartan malaria nephrotic syndrome. Collaborative clinicopathological study in Nigerian children. Lancet. 1972;1:1143-9.
Barsoun RS. Schistosomal glomerulopathies. Kidney Int. 1993;44:1-12.
Doe JY, Funk M, Mengel M, Doehring E, Ehrich JH. Nephrotic syndrome in African children: lack of evidence for tropical nephrotic syndrome?. Nephrol Dialy Transpl. 2006 Mar 1;21(3):672-6.