Predictors of Complications and CKD Progression in Adult Nephrotic Syndrome: A Cohort Study
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Abstract
Background and aims: Nephrotic syndrome (NS) is a glomerular syndrome characterized by massive proteinuria and severe complications, including chronic kidney disease (CKD). This study aimed to describe the demographic, clinical, biochemical, histological, and etiological characteristics of patients with NS, to identify risk factors for complications, and to assess predictors of progression to CKD in a Moroccan setting.
Methods: This retrospective, descriptive, and analytical study was conducted in the Nephrology Department of CHU Ibn Sina, Rabat, Morocco, from 2019 to 2024. It included 308 patients hospitalized for NS, aged >15 years, with proteinuria ≥3.5 g/day and hypoalbuminemia <30 g/L. Data were extracted from medical records and analyzed using Jamovi software. Univariate and multivariable analyses (logistic regression) were performed; p < 0.05 was considered statistically significant.
Results: Mean age was 42.5 ± 15 years, with a sex ratio of 1.03. An edematous syndrome was present in 65.76% of patients, and hypertension in 35%. Median proteinuria was 7 g/24 h, and median serum albumin was 20 g/L. Histologically, focal segmental glomerulosclerosis (FSGS) was the most frequent lesion (26%), followed by lupus nephritis (21%). Primary NS accounted for 50.7% of cases. Complications occurred in 43.4% of patients, including acute kidney injury (36%), infections (10%), and thromboembolic events (3.5%). Complete remission was observed in 54% of patients, while 21% progressed to CKD. Admission serum creatinine was significantly associated with progression to CKD (p = 0.001).
Conclusion: Nephrotic syndrome represents a major clinical burden in nephrology, with a predominance of FSGS and a high rate of CKD. Early detection, multidisciplinary management, and prophylactic interventions are essential to reduce morbidity and slow renal progression. These findings highlight the need for further research and tailored health policies.
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