Prevalence of Histopathological Subtypes Associated with Steroid-Resistant Nephrotic Syndrome in Children: A Systematic Review and Meta-Analysis

Sen Lin¹Shanshan Zheng¹Wanying Dong²Yangyang Tian¹Hao Li¹Xinyuan Gao¹Fang Qin¹Yipeng Liu^3*Chaoqun Ma^4*

• ¹Shandong Provincial Qianfoshan Hospital, Jinan, China
• ²Shandong Second Provincial General Hospital, Jinan, China
• ³Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
• ⁴Shandong Provincial Hospital, Jinan, China

Background: Steroid-resistant nephrotic syndrome (SRNS) in children is associated with various histopathological subtypes ;however, the prevalence of these subtypes remains insufficiently defined. These subtypes often demonstrate variable responses to identical therapeutic regimens and are indicative of distinct clinical outcomes. This systematic review and meta-analysis seeks to comprehensively elucidate the prevalence of the most common histopathological subtypes in pediatric SRNS, offering valuable insights that may inform future therapeutic strategies and improve prognostic predictions for affected patients. Methods: We conducted a comprehensive literature search across four major databases: PubMed, Embase, Web of Science, and Cochrane, with coverage extending from the inception of these databases up to December 2023.Two independent researchers screened the identified studies, selecting only cross-sectional and longitudinal studies that reported the prevalence of histopathological subtypes in pediatric SRNS. The quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist, and only those meeting the required quality criteria were included. Data were extracted from the selected studies using a standardized data extraction form. Meta-analysis was performed with Stata software to estimate the prevalence of different histopathological subtypes in pediatric SRNS. Subgroup analyses were conducted to explore potential sources of heterogeneity. Publication bias was assessed using funnel plots and the Begg test, and sensitivity analysis was also conducted. Results: The most commonly reported histopathological subtypes associated with SRNS in children are focal segmental glomerulosclerosis (FSGS), membranous nephropathy (MN), minimal change disease (MCD), mesangioproliferative glomerulonephritis (MesPGN), and membranoproliferative glomerulonephritis (MPGN). Among these, the subtype with the highest average prevalence is FSGS, at 39%, followed by MCD (27%), MesPGN (23%), MPGN (18%), and MN (4%). Conclusion: FSGS exhibits a notably high prevalence in SRNS and remains the most frequently observed histopathological lesion associated with this condition.