NDT Advance Access published online on October 26, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp536
Quartan malaria-associated childhood nephrotic syndrome: now a rare clinical entity in malaria endemic Nigeria
1 Paediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria 2 Histopathology Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria 3 Microbiology and Parasitology Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
Correspondence and offprint requests to: Correspondence and offprint requests to: Wasiu A. Olowu; E-mail: yetundeolowu{at}yahoo.com
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Abstract |
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Background. The study determined (i) whether or not quartan malaria nephropathy (QMN) is still a major cause of childhood nephrotic syndrome (CNS) in Nigeria, (ii) secondary causes other than QMN and their associated glomerular pathology and (iii) renal and patient outcome.
Methods. The study was a prospective non-randomized study of consecutive cases of secondary CNS. Patients with idiopathic CNS were excluded.
Results. Twenty-four of 78 (30.8%) CNS cases were of secondary aetiology. Overall mean ages at onset of secondary CNS aetiology and CNS onset were 8.97 ± 3.59 (1–15.3) and 9.95 ± 3.15 (5–15.3) years, respectively. Male (14)/female (10) ratio was 1.4. Secondary causes comprised systemic lupus erythematosus (SLE, 37.5%), sickle cell anaemia (SCA, 16.7%), hepatitis B virus (HBV, 16.7%) infection, Churg–Strauss syndrome (12.6%), SLE/human immunodeficiency virus infection (4.2%), rhabdomyosarcoma (4.2%), bee stings (4.2%) and Addison's disease (4.2%). The overall cumulative complete remission (CR) rate was 88.0%. Remission was sustained in 11 of 16 (68.8%) CR patients, while one patient (6.25%) relapsed; the remaining four patients (24.95%) were yet to attain sustained remission. Median relapse-free period was 10.5 (0.75–25) months. Cumulative renal survival was 75.2% at 3 years. Three patients were lost to follow-up, while two died. Overall cumulative patient survival probability at 36 months was 90.8%. All patients were followed for a median period of 12.5 (0.11–36.0) months.
Conclusion. Overall outcome of CNS has improved significantly compared to the 1960s and 1970s when the poor outcome of QMN was the predominant glomerular lesion in Nigeria. While quartan malaria-associated nephrotic syndrome has become a rare clinical entity, SLE, SCA and HBV infection have become the major secondary aetiologies of CNS in Nigeria.
Keywords: lupus nephritis; sickle cell anaemia; viral hepatitis
Received for publication: 26. 5.09
Accepted in revised form: 17. 9.09