Factors Affecting the Statural Growth Retardation in Children using Steroids in Idiopathic Nephrotic Syndrome

Background and Aim: Idiopathic nephrotic syndrome or nephrosis causes massive protein leakage in the urine. Its treatment requires steroids (prednisone, methylprednisolone), often for a prolonged period, notably in case of steroid-dependence or steroid-resistance. In children, long-term use of steroids can lead to several side effects such as statural growth retardation/ stunting. This study evaluated the frequency of stunting in idiopathic nephrotic syndrome in children on steroids and identified the associated factors.     
 Material and Methods: This was a retrospective, descriptive cohort study carried out in children aged 0 to 16 years treated at the paediatric nephrology unit of Aristide Le Dantec Hospital in Dakar, between 1 December 2017 and 31 May 2020. All records of nephrotic children treated in outpatient or inpatient setting were included. These children had to be on corticosteroid therapy for at least 30 months and have a height taken regularly during follow-up consultations.
 Results: Of 259 children followed for idiopathic nephrotic syndrome, 93 were included in the study. The median age was 96.5 months and the sex ratio was 1.9. The mean height of the children at the beginning of the follow-up was -0.26 DS, at the end it was -0.88 DS. At the beginning of the follow-up, 8 children had already stunting. At 12 months follow-up, 72 children (77.4%) had a decrease in z-score; and at 30 months, there were 7 more children (84.9%) who had a decrease in z-score. Methylprednisolone boluses were given to 17 children (18.3%). Calcium supplementation was done in 91 children (97.8%). Vitamin D supplementation was given to 91 children (97.8%). The mean number of relapses was 1.8. Factors associated with stunting were number of relapses ≤3 (p=0.03), duration of corticosteroid therapy >6 months (p<0.0001) and cumulative doses of prednisone >100 mg/kg (p=0.04).
 Conclusion: In prolonged nephrotic syndrome in children, corticosteroids can cause stunting

Epidemiological, clinical and developmental aspects of chronic kidney disease stages 3-5 (CRF) in children in a pediatric hospital in Senegal

Introduction: Our objective in this study was to describe both the epidemiological and clinical aspects and the difficulties of management of childhood CKD stages 3-5 in Senegal in order to express recommendations. Materials and Methods: This was a retrospective study from January 2005 to December 2013 in the pediatric ward of HALD. We included patients under 15years who have been showing for more than three months a glomerular filtration rate (GFR ) of less than 2 60ml/min/1.73 m calculated with the Schwartz formula. Results: We included in our study 53 cases during the study period, showing a p r e v a l e n c e o f 0 . 6 2 % o f hospitalisation. The average age of our patients was 10.6 years. Clinically, edema of renal type was present in 69.8 % of patients , proteinuria in 88.7 % of cases and arterial hypertension in 75.5 % of patients. Biologically , anemia was present in 100% of our patents. Classification of CKD showed that 71.7 % of cases were diagnosed at stage 5 of chronic kidney disease. The most common causal lesion we found consist ed of a cquir ed chronic glomerulopathy (52.8 %). Overall survival in children under hemodialysis for a period of 12 months was 34.3 %. Conclusion : The prevalence of CKD in children in our study was 0.62 %.. Managing such cases is a daily challenge for pediatricians and nephrologists. Hence the interest of building a pediatric nephrology unit.Keywords: Chronic kidney disease (chronic renal failure), Children, Glomerulopathy,Haemodialysis, Sénéga

Glomérulonéphrite lupique classe IV chez une jumelle de 15 ans au service de Pédiatre de l'Hôpital Aristide le Dantec de Dakar

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Aspects epidemiologiques, cliniques et evolutifs de l'insuffisance renale chronique (IRC) chez l'enfant dans un hopital pediatrique Senegalais

Introduction : Notre objectif dans cette étude était de décrire les aspects épidémiologiques, cliniques et les difficultés de prise en charge de l'IRC au S éné g a l a fin d e for mu l e r d e s recommandantions. Materiels et Methodes : Il s'agissait d'une étude rétrospective déscriptive et analytique de Janvier 2005 à Décembre 2013 au sein du service de pédiatrie de l'HALD. Etaient inclus les patients âgés de moins de 15 ans présentant depuis plus de 3 mois un débit de filtration glomérulaire 2 (DFG) inférieur à 60ml/min/1,73 m calculé par la formule de Schwartz. Les données ont été saisies et analysées grâce au logiciel SPSS 16.0. Résultats : Nous avons inclus dans l'étude 53 cas d'IRC durant la période d'étude soit une prévalence en hospitalisation de 0,62%. L'âge moyen chez nos patients était de 10,6 ans. Sur le plan clinique, l'œdème de type rénal était présent chez 69,8% des malades, la 2014;1:83-89 83 *( ) protéinurie dans 88,7% des cas et l'hypertension artérielle chez 75,5% des patients. Sur le plan biologique, l'anémie était présent chez 100% de nos patients. La classification de l'IRC montrait que 71,7% des cas étaient diagnostiqués au stade 5 de la maladie rénale chronique. La lésion causale la plus retrouvée était representée par les glomérulopathies chroniques acquises (52,8%). La survie globale à 12mois, chez les enfants hémodialysés était de 34,3%. Conclusion : La prévalence de l'IRC chez l'enfant dans notre étude est de 0,62%. Les glomérulopathies chroniques représentaient les étiologies les plus fréquentes La mortalité globale est élevée. Nous recommendons la création d'une unité de néphrologie pédiatrique pour une meilleure prise en charge.Motsclés: Insuffisance rénale chronique, Enfants, Glomérulopathie, Hémodialyse, Sénéga