Treatment outcome, selected biochemical profiles, and Associated factors among children diagnosed with nephrotic Syndrome in jimma town hospitals, southwest Ethiopia

Abstract

Background: Nephrotic syndrome (NS) is a common childhood kidney disease characterized by proteinuria, hypoalbuminemia, and edema. It is caused by increased glomerular permeability, leading to proteinuria and biochemical changes like hypoalbuminemia and hyperlipidemia, which raise the risk of cardiovascular disease. Treatment involves corticosteroids, but steroid-resistant cases face a higher risk of chronic kidney disease. Despite its impact, data on certain biochemical profiles and treatment outcome of children diagnosed with NS, especially in resource-limited settings, are limited. Objective: To assess the treatment outcome, selected biochemical profiles, and associated factors among children diagnosed with NS in Jimma town hospitals, Southwest Ethiopia, from December 1, 2023, to April 30, 2024. Methods: An institution-based mixed, prospective and cross-sectional study was conducted among children diagnosed with and treated for NS in Jimma town hospitals, selected through consecutive sampling. The mobile Kobo Toolbox was used to collect data. Five milliliters of venous blood and 20 milliliters of urine were collected from each participant and analyzed for selected biochemical profiles at Jimma Medical Center Laboratory using a Cobas 6000 chemistry analyzer. The collected dataset was exported to SPSS version 25 for analysis. Descriptive and inferential statistics were used to describe and present the data. Bivariate & multivariate logistic regression were used to identify factors associated with the outcome variable, with statistical significance at p-value < 0.05 and 95% confidence interval. Results: The study included 114 children diagnosed with and treated for NS. The mean age of participants was 7.09 ± 2.913 years, with 59.6% being male. The overall proportion of steroid resistance was 13.2% (95% CI: 7.6%-20.8%). The biochemical profile revealed 15.8%, 38.6%, 10.5%, 41.2%, and 63.2% of the participants had low serum albumin, low serum protein, elevated serum creatinine, hypercholesterolemia, and hypertriglyceridemia, respectively. Additionally, hematuria, comorbidities, and infections were present in 15.8%, 7.9%, and 28.1% of the participants, respectively. Older age (> 6 years) (AOR: 5.84; 95% CI: 1.13-26.15), presence of hematuria (AOR: 6.03; 95% CI: 1.25-29.02), low serum albumin level (≤1.5 g/dL) (AOR: 5.75; 95% CI: 1.29-25.43), and hypercholesterolemia (AOR: 5.44; 95% CI: 1.13-26.15) were independent predictors of steroid resistance. Conclusion and Recommendation: Key predictors of steroid resistance include older age at diagnosis, hematuria, low serum albumin, and hypercholesterolemia, highlighting that thorough risk assessments and tailored treatments targeting these factors are crucial to improve patient outcomes.