Idiopathic nephrotic syndrome in children of Voronezh region

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Relevance. Idiopathic nephrotic syndrome is the most frequent form of nephrotic syndrome in children, accounting for
more than 90% of cases between the ages of 1 and 10 years.
and up to 50% of children older than 10 years. [1] This pathology is characterized by the loss of large amounts of protein through the glomerular filter leading to hypoalbuminemia, hyperlipidemia, decreased oncotic pressure and edema. The incidence worldwide ranges from 1.2 - 16.9 cases per 100,000 children with the highest rate in the Indian subcontinent compared to 2-3 cases per 100,000 children in most other regions. [2, 3]
Aim of the study: to study the incidence of INS in Voronezh city and Voronezh region for the period 2018-2023 and to analyze the obtained data by age, sex characteristics and by nosological forms of the disease.

Materials and methods: the case histories of children with nephrotic syndrome in the BUZ VO Voronezh Regional Children's Clinical Hospital №1 (“VODKB №1”) from 01.01.2018 to 31.12.2023 were analyzed.

Study Results. The study found that a total of 128 children aged 1 to 17 years were observed with nephrotic syndrome in VODKB #1 from 2018 to 2023. At the same time, idiopathic nephrotic syndrome was diagnosed in 121 patients (94.5%).
When analyzing the number of hospitalizations, it was found that this indicator was quite unstable by years. Thus, the minimum number (58 hospitalizations) was noted in 2020, which is probably associated with quarantine measures for COVID-19 coronavirus infection, and the maximum - in 2022 (103 hospitalizations). A total of 503 cases of hospitalization of patients with INS were registered in BUZ “VODKB №1” for 6 years.
The dynamics of morbidity by years was as follows: for 2018 - 2.7 per 100,000 children, for 2019 - 1.54 per 100,000 children, 2020 - 2.05 per 100,000 children, 2021 - 3.06 per 100,000 children, 2022 - 1.79 per 100,000 children and in 2023 - 1.29 per 100,000 children. The average incidence of INS was 1.97 cases per 100,000 child population. The prevalence was 20.49 per 100,000 children.

Table 1.
Number of children with NS treated in the nephrology department of BUEZ VO “VODKB №1” in the period 2018-2023.

Year	Number of hospitalizations (n)	Incidence (per 100,000 child population)
2018	84	2,07
2019	82	1,54
2020	58	2,05
2021	83	3,06
2022	103	1,79
2023	93	1,29
Total	503	1,97

 

When evaluating the debut of INS according to age, the following information was obtained: the most frequent (57.8% of cases) debut of the disease is between 1 and 4 years of age, slightly less frequently (40% of cases) - between 5 and 9 years of age and most rarely (2.2% of cases) in 10-14 years of age.

Table 2.
The debut of INS depending on age in children treated in the nephrology department of BUZ VO “VODKB №1” in the period 2018-2023.

Age of debut, years (n)	Number of children (n)	%
1-4	26	57,8%
5-9	18	40,0%
10-14	1	2,2%
15-17	0	0
Total	45

 

In this connection, the morbidity of children in different age groups was quite heterogeneous. Thus, in the group of children aged 1-4 years it amounted to 4.12 cases per 100,000 child population, in the group of 5-9 years - 2.38 cases per 100,000 child population, in 10-14 years - 0.14 cases per 100,000 child population, and in the age category of 15-17 years there were no registered cases.
When analyzing the sex structure, a significant predominance of boys was found: the ratio of boys:girls was 1.7:1. This trend was observed throughout the study period.

Table 3.
Incidence of INS children treated in the nephrology department of BUZ VO “VODKB №1” for the period 2018-2023, taking into account gender

 

Year	Boys:girls ratio (n)
2018	1,7:1
2019	2:1
2020	1,7:1
2021	1,4:1
2022	7:0
Total	1,7:1

 

When studying the structure of INS in children in the Voronezh region, it was noted that the most common form of NS is the steroid-sensitive variant, registered in 91.7% of cases. The steroidresistant form is much less common (8.3% of cases). Infrequently recurrent NS prevails among steroid-sensitive forms (70.1%), steroid-dependent (23.4%) and frequently recurrent NS (6.5%) are less common.

Table 4.
Structure of INS in children from 1 to 17 years old
in the Voronezh region, treated in BUEZ VO “VODKB №1”
in the period 2018-2023

INS variant	Number of children (n)	%
Steroid-sensitive	77	91,7%
Steroid-resistant	7	8,3%
Total	84

Table 5.
Structure of steroid-sensitive NS in children from 1 to 17 years old
in Voronezh region, treated in BUEZ VO “VODKB №1”
in the period 2018-2023

A type of steroid-sensitive NS	Number of children (n)	%
Infrequently recurrent	54	70,1%
Recurrent	5	6,5%
Steroid-dependent	18	23,4%

Conclusion. Thus, the incidence of INS in children of the Voronezh region from 1-17 years of age for the period 2018-2023 amounted to 1.97/100000 children. The prevalence of INS on 01.01. 2024g. - 25,47 /100000 children population. The debut of INS was more often before the age of 4 years (57.8%). The ratio of boys to girls was 1.7:1. The steroid-sensitive variant (91.7%) predominated in the structure of INS, among which 6.5% accounted for recurrent and 23.4% for steroid-dependent NS. The incidence of INS in HE children has slightly decreased in the last 6 years, compared to 1992-2006. Despite this, the study of the epidemiologic situation and risks of INS exacerbations remains important and relevant to assess the burden of disease and to make decisions regarding the care of children with NS.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

About the authors

Maya Prokhorova

Voronezh State Medical University named after N.N. Burdenko

Email: prohorova_mayya@mail.ru
ORCID iD: 0009-0002-7628-4129

5th-year student of pediatric faculty

Russian Federation, 10 Studencheskaya St., Voronezh, Russia;

Tatiana Leonidovna Nastausheva

Burdenko Voronezh State Medical University

Author for correspondence.
Email: nastat53@mail.ru
ORCID iD: 0000-0001-6096-1784

Doctor of Medical Sciences, Professor, Head of the Department of Hospital Pediatrics, N.N. Burdenko Voronezh State Medical University

Russian Federation, 394036, Россия, Воронеж, ул. Студенческая, д. 10

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