Vol. 6, Issue 1, Part A (2024)

Introduction: Nephrotic syndrome is a prevalent kidney disorder in children, affecting approximately 11.6 per 100, 000 children, with a male-to-female ratio of 1.3:1. Current interventions have been advanced to increase the survival rate below 3%. Although steroids are the mainstay of therapy, non-steroidal immunomodulating agents are also employed to reduce the side effects of corticosteroids and promote long-term cure. Objectives: The purpose of this research is to evaluate adverse effects of steroids and other immunosuppressive agents in paediatric nephrotic syndrome patients, to determine the drug-related morbidity, improve the patients’ quality of life, and thereby maintain remission.
Materials and Methods: This cross-sectional, archival study involved children 1-18 years who were diagnosed with nephrotic syndrome and sought care at the Pediatric Nephrology Consult Clinic, Al-Zahraa Teaching Hospital, Wasit, Iraq over the period of 2017 to 2024. From a total of 206 patients with nephrotic syndrome, 93 patients with steroid-dependent and frequently relapsing disease were enrolled. Each individual also received a clinician assessment and biological assessments with recurrent assessment. Inclusion Criteria: Children and adolescents, one to eighteen years of age with steroid dependent and frequently relapse nephrotic syndrome under steroid and/or immunosuppressive treatment. Exclusion Criteria: These populations have been excluded; patients older than 18 yr, those with steroid-resistant or steroid-sensitive nephrotic syndrome, the atypical, patients with incomplete clinical records, congenital and infantile nephrotic syndrome, and nephrotic syndrome secondary to systemic diseases such as diabetes, Henoch-Schonlein purpura, and SLE. Informed Consent: All participants were briefed of the purpose of the study and agreed verbally to use their data in the study thereby maintaining anonymity and ethical practices.
Results and Discussion: Out of the 93 patients, 60.2% were found to have frequently relapsing nephrotic syndrome (FRNS) and 39.8% to have steroid-dependent nephrotic syndrome (SDNS). The majority of these patients were male (2.3). These results are slightly higher than those of previous research projects with similar designs (p<0.05, Cohen's d= 0.15 t(90) = 2.207). Five years old was found to be the median age of the patients upon diagnosis. Nearly 70% reported being born into the same family as someone else, and 30% said they knew someone with a history of positive consanguinity. While steroids were given to all patients, rituximab was seldom recommended and MMF was the most often used second-line immunosuppressive drug. A total of 89.9% of STS-related problems were associated with steroids, 66.6% with rituximab, and 60.8% with cyclosporine. With only 16.6% of patients experiencing mild and completely reversible toxicities, levamisole had the fewest problems.
Conclusion: Nephrotic syndrome is not easy to manage some drugs that contribute to the protracted remission such as rituximab cyclosporine, has some side effects. MMF was the most associated drug, accounted for 52.3% of preventable adverse reactions. Controlling this might be easier with tacrolimus than cyclosporine simply because it has fewer complications and better tolerance. Namely the cyclophosphamide negative side effects were not observed in 78.5%, levamisole negative side effects were not observed in 83.3 %, the p-value < 0.001.