HEALTH-RELATED QUALITY OF LIFE OF CHILDREN WITH NEPHROTIC SYNDROME SEEN AT THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL, ENUGU

Abstract

Nephrotic syndrome is a common chronic kidney disease of childhood whose characteristics and
processes can significantly affect the health-related quality of life (HRQoL) of affected
individuals. The goals of treatment of chronic diseases have evolved over time from mere
survival to achievement of a certain level of well-being. The assessment of HRQoL using
specific tools conveys vital information about a patient which is not accessible through the
routine clinical or conventional laboratory or radiological assessment. There is a lack of
information regarding the health-related quality of life of children with nephrotic syndrome in
Enugu state and its environs.
This study was cross sectional and comparative. It was undertaken to assess the health-related
quality of life of children with nephrotic syndrome and to compare this with that of apparently
healthy age and sex matched controls. To achieve this, the study sought to determine the effect of
nephrotic syndrome on physical, social, emotional, and school functioning of affected children.
Furthermore, it sought to determine the influences of age, gender, socioeconomic status, disease
characteristics, and duration of illness on health-related quality of life of these children.
A total of 100 children aged five to eighteen years were recruited over a nine month period from
February to October 2015. This number comprised 50 children with nephrotic syndrome
recruited as subjects from the nephrology clinic of University of Nigeria Teaching Hospital,
Ituku-Ozalla, Enugu and 50 apparently healthy children recruited from two schools within Enugu
metropolis. The subjects comprised 33 males and 17 females approximately in the ratio of 1.9:1,
matched age and sex with the healthy controls. The socio-demographic characteristics and the
clinical history of the respondents were obtained and recorded in a proforma designed for the
study. The health-related quality of life of all the study participants was assessed with PedsQLTM
4.0 Scale Score.
The health-related quality of life scores of children with NS were significantly lower than those
of healthy controls (p < 0.001). All the domains on the PedsQL scale were negatively affected,
with the worst scores in the school functioning domain. The mean PedsQL scores in the school
domain were 59.70 ± 18.56 in children with NS compared with 89.40 ± 8.12 seen in healthy
control (p < 0.001). Emotional functioning was negatively affected by increasing age.
Adolescents had a significantly lower emotional score of 67.00 ± 25.58 than 98.50 ± 3.66 scored
by children aged five to nine years (r = – 0.754, p < 0.001). There was no relationship between
gender, socioeconomic status, and HRQoL of these subjects. The predictors of poorer scores
included presence of oedema (46.54 ± 14.77, p = 0.002), high degree of proteinuria (40.42 ±
14.22, p < 0.001), non-minimal change histology type (62.78 ± 24.15, p < 0.001) steroid
resistance (65.75 ± 23.58, p = 0.002), and duration of illness (65.63 ± 24.33, p = 0.002 for
shorter duration and 75.64 ± 27.03, p = 0.035 for longer duration).
It was thus concluded that the HRQoL of children with nephrotic syndrome is significantly lower
than that of apparently healthy children, and this affects all assessment domains, and worsens
with presence of symptom, disease severity (massive proteinuria, steroid resistance, non-MCNS
histology type, cytotoxic therapy), and duration of illness. Therefore, it is recommended that the
assessment of HRQoL of children with nephrotic syndrome should become a component of
clinical care. Efforts should be made towards relieving of symptom, and attaining and sustaining
remission. The emotional and the schooling challenges frequently encountered should also be
addressed.