Management practices of Childhood Steroid Sensitive Nephrotic Syndrome among Paediatric Nephrologists/Paediatricians in Nigeria

Abstract

Aim: To describe the management practices for childhood nephrotic syndrome among paediatric nephrologists / paediatricians in centres offering paediatric renal services in Nigeria.

Method: A cross-sectional online survey was conducted between 5th December 2022 to 5th January 2023 among paediatricians / paediatric nephrologists in 35 facilities that manage children with nephrotic syndrome. The steroid-prescribing patterns for steroid-sensitive nephrotic syndrome (SSNS), steroid-sparing medications usage and in relapses were assessed. 

Result: Out of respondents surveyed, 32 (91.4%) completed the online survey and they were from the six geopolitical zones in Nigeria. Two-fifths (40.6%) practised paediatrics/paediatric nephrology for ≥ 10 years and a half (50%) practised in federal teaching hospitals. For new-onset nephrotic syndrome, 84.4% of respondents would prescribe prednisolone at 60mg/m2/day, with an initial daily prednisolone duration of 4, 6, and 8 weeks in 15.6%, 37.5% and 28.1% respondents respectively and total prednisolone duration of 8, 12, and 16 weeks in 29.1%, 37.5% and 15.6% respectively. There were marked variations in the use of adjunct medications as well as the duration of steroid-sparing medications and prednisolone dosage and treatment duration in those with frequent and infrequent relapses (FRNS), steroid-dependent nephrotic syndrome (SDNS).  

Conclusion: The management of new-onset steroid-sensitive nephrotic syndrome was considerably in-keeping with international guidelines. However, wide variations exist for the choice of steroid-sparing medications and treatment of relapses and SDNS, strengthening need for a national guideline and continuous training among paediatricians and nephrologists.