Saudi Journal of Kidney Diseases and Transplantation

LETTER TO THE EDITOR
Year
: 2014  |  Volume : 25  |  Issue : 5  |  Page : 1089--1090

Remarks about the study on patterns of childhood nephrotic syndrome in Aljouf region, Saudi Arabia


Mahmood Dhahir Al-Mendalawi 
 Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

Correspondence Address:
Prof. Mahmood Dhahir Al-Mendalawi
Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
Iraq




How to cite this article:
Al-Mendalawi MD. Remarks about the study on patterns of childhood nephrotic syndrome in Aljouf region, Saudi Arabia.Saudi J Kidney Dis Transpl 2014;25:1089-1090


How to cite this URL:
Al-Mendalawi MD. Remarks about the study on patterns of childhood nephrotic syndrome in Aljouf region, Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2014 [cited 2022 Oct 2 ];25:1089-1090
Available from: https://www.sjkdt.org/text.asp?2014/25/5/1089/139950


Full Text

To the Editor,

With reference to the interesting study by Alhassan et al, [1] idiopathic nephrotic syn­drome (INS) in children has conventionally been associated with minimal change nephro-pathy (MCN). However, recent reports have suggested that the frequency of focal seg-mental glomerulosclerosis (FSGS) in children might be on the increase worldwide. [2],[3] Racial and ethnic background is thought to have a substantial influence on the incidence and progression of FSGS in children and adults. It is likely that specific genes or a combination of genes influence the different clinical mani­festations of FSGS in racial and ethnic groups. [4] The shift toward an increasing prevalence of FSGS in children with INS over the past years in the Kingdom of Saudi Arabia has been noticed. Mattoo et al [5] showed in their clinico-pathological study of children with INS that 39% had FSGS, 35% had diffuse mesangial proliferative glomerulonephritis (MesPGN) and 21% had MCN. Kari [6] also demonstrated that the incidence of FSGS was significantly greater in kidney biopsies performed in the period of 1997-2001: 35%, versus 16.7% in the period of 1983-1992, P = 0.05. Additionally, Kari et al [7] addressed that FSGS (39%) was the most common underlying histopathology in steroid-resistant nephrotic children, followed by IgM nephropathy (28%), MesPGN (17%), MCN and C1q nephropathy (8% each) and IgA nephropathy (3%). Recently, Al Salloum et al [8] revealed the preponderance of FSGS (34.3%) among a cohort of biopsied nephrotic chil-dren. [8] Surprisingly, only three (1.2%) of 25 nephrotic children were proven to have FSGS in Alhassan et al's study. [1] I presume that such a low frequency of FSGS does not truly reflect the changing histopathology pattern of childhood NS compared with anecdotal Saudi studies. In fact, it might reflect the confounding effects of two important limitations in Alhassan et al's study, [1] notably small studied cohort (n = 25) and relatively short study period (2005-2010). This, subsequently, might cast some suspi­cions on their conclusion that patterns of NS observed in their study did not differ signi­ficantly from studies from other places in the world.

Conflict of Interest: None

Author's Reply

Reply from the authors is awaited.

References

1Alhassan A, Mohamed WZ, Alhaymed M. Patterns of childhood nephrotic syndrome in Aljouf region, Saudi Arabia. Saudi J Kidney Dis Transpl 2013;24:1050-4.
2Filler G, Young E, Geier P, Carpenter B, Drukker , Feber J. Is there really an increase in non-minimal change nephrotic syndrome in children? Am J Kidney Dis 2003;42:1107-13.
3Borges FF, Shiraichi L, da Silva MP, Nishimoto EI, Nogueira PC. Is focal segmental glomerulosclerosis increasing in patients with nephrotic syndrome? Pediatr Nephrol 2007;22: 1309-13.
4Andreoli SP. Racial and ethnic differences in the incidence and progression of focal seg-mental glomerulosclerosis in children. Adv Ren Replace Ther 2004;11:105-9.
5Mattoo TK, Mahmood MA, al-Harbi MS. Nephrotic syndrome in Saudi children clinico-pathological study of 150 cases. Pediatr Nephrol 1990;4:517-9.
6Kari JA. Changing trends of histopathology in childhood nephrotic syndrome in western Saudi Arabia. Saudi Med J 2002;23:317-21.
7Kari JA, Halawani M, Mokhtar G, Jalalah SM, Anshasi W. Pattern of steroid resistant nephrotic syndrome in children living in the kingdom of Saudi Arabia: A single center study. Saudi J Kidney Dis Transpl 2009;20: 854-7.
8Al Salloum AA, Muthanna A, Bassrawi R, Al Shehab AA, Al Ibrahim A, Islam MZ, et al. Long-term outcome of the difficult nephrotic syndrome in children. Saudi J Kidney Dis Transpl 2012;23:965-72.