Ajarmeh SA, Akl K, Al Shawabkeh M, Al Baramki J. Steroid response and outcomes in childhood nephrotic syndrome: A multicenter, cross-sectional study from Jordan. World J Clin Pediatr 2025; 14(4): 109671 [DOI: 10.5409/wjcp.v14.i4.109671]
Corresponding Author of This Article
Salma A Ajarmeh, MD, Associate Professor, Consultant, Department of Pediatrics, Mutah University, University Street, Karak 61710, Karak, Jordan. ajarima@mutah.edu.jo
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Pediatrics
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Oct 31, 2025
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World Journal of Clinical Pediatrics
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2219-2808
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Ajarmeh SA, Akl K, Al Shawabkeh M, Al Baramki J. Steroid response and outcomes in childhood nephrotic syndrome: A multicenter, cross-sectional study from Jordan. World J Clin Pediatr 2025; 14(4): 109671 [DOI: 10.5409/wjcp.v14.i4.109671]
World J Clin Pediatr. Dec 9, 2025; 14(4): 109671 Published online Dec 9, 2025. doi: 10.5409/wjcp.v14.i4.109671
Steroid response and outcomes in childhood nephrotic syndrome: A multicenter, cross-sectional study from Jordan
Salma A Ajarmeh, Kamal Akl, Muna Al Shawabkeh, Jumana Al Baramki
Salma A Ajarmeh, Department of Pediatrics, Mutah University, Karak 61710, Karak, Jordan
Salma A Ajarmeh, Department of Pediatrics, Karak Governmental Hospital, Karak 17160, Jordan
Kamal Akl, Department of Pediatric Nephrology, Jordan University Hospital, University of Jordan, Amman 11942, Jordan
Muna Al Shawabkeh, Department of Medicine, Mutah University, Karak 61710, Karak, Jordan
Jumana Al Baramki, Department of Pediatrics, School of Medicine, Jordan University Hospital, University of Jordan, Amman 11942, Jordan
Author contributions: Ajarmeh SA, Al Shawabkeh M, AL Baramki J, and Akl K contributed to the study conception and design; Ajarmeh SA, AL Baramki J, and Akl K performed material preparation, data collection, and data analysis; Ajarmeh SA wrote the manuscript draft and its revisions, with all authors providing feedback on all versions; Ajarmeh SA, Al Shawabkeh M, AL Baramki J, and Akl K read and approved the final manuscript.
Institutional review board statement: This study was approved by the Institutional Ethics Committee of Mutah University (IRB approval number: 292022).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: The authors have declared that no conflict of interest exists.
Data sharing statement: Data are available from the corresponding author upon reasonable request for academic purposes.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salma A Ajarmeh, MD, Associate Professor, Consultant, Department of Pediatrics, Mutah University, University Street, Karak 61710, Karak, Jordan. ajarima@mutah.edu.jo
Received: May 18, 2025 Revised: June 19, 2025 Accepted: July 15, 2025 Published online: December 9, 2025 Processing time: 166 Days and 17.2 Hours
Abstract
BACKGROUND
Childhood nephrotic syndrome (NS) outcomes vary widely based on steroid responsiveness and complications.
AIM
To evaluate steroid response, outcomes, and the use of steroid-sparing medications in children with nephrotic syndrome in Jordan.
METHODS
This retrospective study evaluated the demographics and outcomes of 122 children aged 1–18 years with NS between 2011 and 2021 across three centers in Jordan. The outcomes assessed included steroid sensitivity rates, dependence, frequent relapses, complications [chronic kidney disease (CKD), end-stage kidney disease (ESKD)], infections, and need for steroid-sparing treatment.
RESULTS
Of 64% were boys; median age of disease onset was 4 years. Steroid-sensitive and steroid-resistant NS (SRNS) were observed in 81.1% and 18.9% of patients, respectively; 28.7% and 9% had steroid-dependent and frequently relapsing NS, respectively. Kidney biopsies were conducted in 46.7%, the most common finding was minimal change disease in 56.1%; 82.6% of biopsied SRNS cases showed focal segmental glomerulosclerosis. The median time to first relapse was 9 months. 41.8% of patients required steroid-sparing medications, with cyclosporine and mycophenolate mofetil being the most frequently used. Despite these treatments, relapse occurred in 11.5% of cases. Infections, primarily urinary tract infections, affected 24.6% of patients, 7.4% progressed to high-grade CKD, and 6.6% required dialysis. SRNS was significantly associated with hematuria, hypertension, and ESKD.
CONCLUSION
Most patients were steroid sensitive, with minimal change being the most common. Focal segmental glomerulosclerosis was the predominant histopathology in the steroid-resistant cases. SRNS patients had worse outcomes, with more infections, CKD, and ESKD.
Core Tip: This retrospective study highlights the outcomes of nephrotic syndrome in Jordanian children, demonstrating that steroid resistant and frequent relapser have higher complication rates. It also emphasizes the importance of early identification and follow-up.
