Increased steroid responsiveness of young children with nephrotic syndrome in Nigeria A. O. ASINOBI, R. A. GBADEGESIN & O. O. OGUNKUNLE Department of Paediatrics, University College Hospital, Ibadan, Nigeria (Accepted April 2005) Abstract A previous study on the nephrotic syndrome (NS) in our unit showed that the histological patterns associated with steroid resistance were more common in children over 5 years of age. Aim: The aim of the study was to determine the incidence of steroid-responsiveness amongst nephrotic children (5 years. Subjects and methods: All children with NS aged (5 years at the onset of disease presenting to University College Hospital, Ibadan were enrolled. Prednisolone was given daily, 60 mg/m 2 , for 4 weeks and then 40 mg/m 2 on alternate days for at least 12 weeks. Results: Twenty children (9 boys and 11 girls) were enrolled between 1999 and 2002. The median age (range) at onset of disease was 4 (2–5) years. Remission was achieved in 12 (60%) children. Conclusion: There is a satisfactory response to prednisolone in two-thirds of Nigerian children aged (5 years with NS. Introduction The nephrotic syndrome (NS) is the most common chronic renal disease of child- hood. 1 In Europe and North America, idiopathic NS constitutes about 90% of cases, with minimal change nephropathy being responsible for 85% of these. 2 Over 90% of children with minimal change nephropathy respond to corticosteroid ther- apy although some have relapses until the 2nd decade of life. 2–4 The prognosis is generally good. 4–6 However, the increasing incidence of focal segmental glomerulo- sclerosis, which is associated with steroid- resistant NS and progression to end-stage renal disease in North America and some other parts of the world, has become a source of concern. 7–11 Racial differences in steroid responsiveness in NS have also been clearly demonstrated, with Hispanics and Blacks in the US being more likely than Whites to be unresponsive to steroids. 12 In the tropics, in contrast with the pattern in temperate climates, the overall picture is characterised by older age at onset of NS, rarity of minimal change disease, association with infectious agents, variable but relent- less progression to chronic renal insuffi- ciency and a high mortality rate. 13–21 The demonstration by previous workers in our unit that steroid therapy in Nigerian chil- dren with NS produced severe side-effects with little therapeutic benefit resulted in abandoning prednisolone as the drug of first choice. 13,17,19 Additionally, Coovadia et al. in South Africa suggested that steroid therapy in African children was rarely beneficial and might even be harmful. 22 Kibukamusoke et al. found the same in Ugandan children. 14 However, in a more recent study in eastern Nigeria, Eke & Eke documented 22.5% steroid sensitivity in nephrotic patients. 23 Reprint requests to: Dr A. O. Asinobi, Department of Paediatrics, University College Hospital, Ibadan, Nigeria. E-mail: adasinobi@yahoo.com Annals of Tropical Paediatrics (2005) 25, 199–203 # 2005 The Liverpool School of Tropical Medicine DOI: 10.1179/146532805X58139