Glomerulonephritis in children: experience from the Kuwait renal centers

ABSTRACT

To study the clinical, pathological, and epidemiological features of childhood steroid-refractory idiopathic glomerulonephritis [SRIGN], i.e., nephrotic syndrome, which failed an 8-week course of prednisone, and secondary forms of glomerulonephritis [GN] in Kuwait. Data on these two forms of GN were collected retrospectively from the records of children attending the two renal centers of Kuwait between January 1, 1990, and December 31, 1996. During the 7 years, a total of 80 children were diagnosed to have GN, 56 of whom were Kuwaiti nationals. In the latter group, 34 children had SRIGN. Hence, the calculated annual incidence rate of Kuwaiti children with both GNs was 3.1 per million and that for SRIGN was 1.9 per million children. Histologically, 22 [65%] of these patients had minimal change, 5 [16%] focal segmental, 2 [6%] non-IgA mesangioproliferative, and 1 membranous GN. Congenital nephrotic syndrome, membranoproliferative GN, and GN secondary to parasitic infestations or microbial infections were not seen in the Kuwaiti children, and nephrotic syndrome secondary to IgA glomerulopathy was diagnosed in 1 patient only. Aggressive autoimmune diseases such as systemic lupus erythematosus [SLE] and vasculitis were common. Seven patients had SLE which accounted for 44% of secondary GN and for 14% of all the patients included in the study, while 3 patients were found to have vasculitis. Interestingly, only 3 of the 13 patients with SLE and vasculitis presented with rapidly progressive GN. Conclusions: The pattern of renal disease associated with SRGN in Kuwaiti children is different from that reported from neighboring countries and other Arab states. The homogeneity of the population studied, lack of endemic infections or parasitic infestations, and genetic predisposition may have been the underlying factors. Furthermore, the high incidence of the insidious kidney-limited disease associated with SLE and vasculitis is another feature which indicates a more aggressive diagnostic approach in the management of GN in our area