Socio-demographic characteristics and clinical parameters
The study included a total of 103 children with nephrotic syndrome. Of these 61 (59.22%), 42 (40.78%) were males and females, respectively. The male-to-female ratio was 1.45 to 1. From the total study population, 75 (72.82%) lived in rural areas, and the rest (28 (27.18%) lived in urban areas. The mean age of the study population was 8 (± 4.03 SD) years. The mean body mass index (BMI) was 16.25 (± 3.54 SD) kg/m2.
Fourteen (21.4%) of the study participants were steroid dependent, and 9.7% of them had steroid-resistant nephrotic syndrome. Around 36.89% of the study participants were in a remission state, and 32.03% were diagnosed with a relapse. The median systolic blood pressure of children with nephrotic syndrome was 110 mm-Hg, with an IQR of 100–121 mm-Hg. The median diastolic blood pressure was 70 mm-Hg, with an IQR of 65–85 mm-Hg.
Four children with nephrotic syndrome had a family history of renal disease. Three children with nephrotic syndrome had a history of bee stings before they developed nephrotic syndrome. Among the study participants, 3.9% had a self-history of atopy. Among the study participants, about 33.01% used anti-hypertensive medications. The most commonly prescribed anti-hypertensive drug by the treating physician was furosemide. The indications were hypertension in 15 (14.56%), respiratory distress in 12 (11.6%), and genital edema in 7 (6.8%). Around 7.76% of the study participants had a history of non-steroidal anti-inflammatory drug (NSAID) intake (Table 1).
Table 1
Descriptive findings among children with nephrotic syndrome age 2-18years attending pediatric follow-up clinic at selected referral hospitals in northwest and east Amhara region, 2022 (n = 103).
Variable | Frequency | Percentage | P-value |
Age: | < 8 year | 58 | 56.3 | 0.314 |
≥ 8 year | 45 | 43.7 | |
Sex | Male | 61 | 59.22 | 0.053* |
Female | 42 | 40.78 | |
Residence | Rural | 75 | 72.82 | 0.020* |
Urban | 28 | 27.18 | |
Chief complaint | FP &HM | 9 | 8.74 | 0.285 |
GBS | 94 | 91.26 | |
Serum albumin: | Mean = 1.904 (± 0.381SD) | 0.006* |
Cholesterol | Mean = 396.65 ±(11.98SD) | 0.316 |
Triglyceride | Mean = 330.59 ± (13.99 SD) | 0.732 |
Hematocrit | Mean = 35.35 ±(0.92SD) | 0.048* |
Platelet count | Mean 357,728.9 ±(13,353.05SD) | 0.096* |
Serum creatinine | Mean = 0.74±(0.05SD) | 0.573 |
Proteinuria | < 3 | 15 | 14.56 | 0.267 |
≥ 3+ | 88 | 85.44 | |
Hematuria | Yes | 57 | 55.34 | 0.000* |
No | 46 | 44.66 | |
Hypertension | Yes | 15 | 14.56 | 0.752 |
No | 88 | 85.44 | |
HIV infection | Yes | 5 | 4.85 | 0.372 |
No | 98 | 95.15 | |
Prednisolone | Yes | 32 | 31.1 | 0.315 |
No | 71 | 68.9 | |
GBS-generalized body swelling, FP- facial puffiness, HM- hematuria
Prevalence of Infection among nephrotic syndrome children
In this study, the prevalence of infection among nephrotic syndrome children was 39.8% (95% CI: 30.7, 49.7). Among three children with nephrotic syndrome, one had any of the infections at any time in the course of the disease. The types of infections identified were pneumonia, urinary tract infection, spontaneous bacterial peritonitis, diarrheal disease, cutaneous fungal infection, intestinal parasitic infection, and sepsis. The most common types of infections were parasitic infections, urinary tract infections, pneumonia, and spontaneous bacterial peritonitis (Table 2). Children with infections were presented with different clinical presentations (Fig. 1). Among patients with relapse, 10/32 (31%) had an infection. In addition, of steroid-dependent nephrotic syndrome children, 9/22 (41%) had an infection. In patients with steroid-resistant nephrotic syndrome, 7/10 (70%) had an infection. Around 16% of nephrotic syndrome children had urinary casts. Among these, 12/16 (75%) had an infection. In children with infection and nephrotic syndrome, 11/32 (34.4%) were taking prednisolone
Table 2
types of infection identified in children with nephrotic syndrome attending pediatric follow-up clinic at selected referral hospitals in northwest and east Amhara region, 2022 (n = 103).
Types of infection | frequency | Percentage |
Parasitic infection | 11 | 10.67 |
Urinary tract infection (UTI) | 9 | 8.73 |
Spontaneous bacterial peritonitis (SBP) | 8 | 7.76 |
Pneumonia | 8 | 7.76 |
Cutaneous fungal infection | 6 | 5.83 |
Acute gastroenteritis | 4 | 3.88 |
Sepsis | 2 | 1.94 |
Others | 3 | 2.91 |
Factors associated with Infection
We used binary logistic regression to identify potential variables associated with infection in nephrotic syndrome. The variables with a p-value of < 0.2 by binary logistic regression analysis were sex, residence, serum albumin, hematuria, anti-hypertensive drug use, steroid dependence, urinary cast, total serum protein, platelet count and hematocrit. The forward conditional regression analysis was used to identify factors associated with infection. So, serum albumin level, residence, and hematuria were the factors significantly associated with infection. The odds of infection were reduced by 7% with each unit of serum albumin increment (AOR = 0.93, 95% CI: 0.87, 0.988). Children with nephrotic syndrome from rural residences increased the likelihood of infection by 3.31 compared to urban residences (AOR = 3.31, 95% CI: 1.09, 10.1). The odds of infection were more than five times higher among patients with hematuria (AOR = 5.26, 95% CI: 2.03, 13.64) (Table 3).
Table 3
Factors associated with infection among children with nephrotic syndrome age 2–18 years attending pediatric clinic at referral hospital in northwest and east Amhara region, 2022.
Variable | Infection | COR (95% CI) | AOR (95% CI) | p-value |
Yes | No |
Residence | Urban | 6 | 22 | 1 | 1 | |
Rural | 35 | 40 | 3.21(1.17,8.81) | 3.31(1.09,10.1) | 0.035* |
Serum albumin | 0.92(0.87–0.978) | 0.93(0.87,0.988) | 0.020* |
Hematuria | Yes | 9 | 32 | 5.26(2.15–12.90) | 5.26(2.03,13.64) | 0.001** |
No | 37 | 25 | 1 | 1 | |
Level of significance- * 95% CI, ** 99% CI