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Prevalence rates of histopathologic subtypes associated with steroid resistance in childhood nephrotic syndrome in Sub-Saharan Africa: a systematic review

Authors Uwaezuoke SN, Ndu IK, Mbanefo NR

Received 2 March 2019

Accepted for publication 22 May 2019

Published 8 July 2019 Volume 2019:12 Pages 167—176


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Pravin Singhal

Samuel N Uwaezuoke,1 Ikenna K Ndu,2 Ngozi R Mbanefo1

1Pediatric Nephrology Firm, Department of Pediatrics, College of Medicine, University of Nigeria Nsukka/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; 2Department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria

Introduction: The prevalence rates of the common histopathologic subtypes of childhood nephrotic syndrome associated with steroid resistance appear to be changing globally. In Sub Saharan Africa (SSA), the trend is similar over the past few decades.
Aim: This systematic review aims to determine the current prevalence rates of the histopathologic subtypes associated with childhood steroid-resistant nephrotic syndrome (SRNS) in SSA.
Methods: A search of the PubMed, Google and African Journals Online databases was conducted from January to December 2018 using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow-chart to identify relevant articles which met the aim of the systematic review. A qualitative synthesis and descriptive analysis of the extracted data were then conducted. The mean values for the prevalence rates of the reported histopathologic subtypes were calculated. A meta-analysis was not done due to few numbers of studies reviewed. The review is registered with PROSPERO, number CRD42018111916.
Results: In the West African sub-region, the currently reported histopathologic subtypes associated with childhood nephrotic syndrome are focal segmental glomerulosclerosis (FSGS), minimal-change nephropathy (MCN), membrano-proliferative glomerulonephritis (MPGN), membranous nephropathy (MN) and mesangial proliferative glomerulonephritis (MesPGN). The picture is the same in South Africa. More importantly, the predominant histopathologic lesions associated with steroid resistance are FSGS (West Africa) and MCN/FSGS (South Africa), with mean prevalence rates of 57.2% and 36.1% respectively.
Conclusion: The prevalence of FSGS is currently high in childhood nephrotic syndrome in SSA. This histopathologic subtype remains the commonest lesion associated with SRNS in this part of the globe.

Keywords: steroid-resistant nephrotic syndrome, children, histopathologic subtypes, focal segmental glomerulosclerosis, prevalence, Sub-Saharan Africa

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