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[Alternate day corticosteroid therapy and growth in renal transplant children]
Insights
Alternate-day corticosteroid therapy can improve growth in pediatric kidney transplant patients. This approach protects growth potential without compromising renal function, offering a better alternative to daily steroids.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
- Endocrinology
Background:
- Corticosteroids are a primary cause of growth stunting in pediatric renal transplant recipients.
- Immunosuppression regimens often include prednisone, impacting long-term growth outcomes.
- Optimizing growth is crucial for the well-being of pediatric transplant patients.
Purpose of the Study:
- To compare the effects of daily versus alternate-day corticosteroid therapy on growth in pediatric renal transplant recipients.
- To evaluate the safety and efficacy of alternate-day prednisone in preserving renal function.
- To identify strategies for mitigating corticosteroid-induced growth impairment.
Main Methods:
- A randomized study involving 35 pediatric kidney transplant recipients with normal renal function.
- Patients were randomized to either daily (Group A) or alternate-day (Group B) corticosteroid therapy 18 months post-transplant.
- Growth parameters and renal function were monitored over the study period.
Main Results:
- Children on alternate-day therapy (Group B) showed catch-up growth in the prepubertal phase.
- Significantly greater statural gain was observed in pubertal children on alternate-day therapy (5.6 cm vs. 3.2 cm).
- Switching Group A patients to alternate-day therapy resulted in improved growth, with no adverse effects on renal function.
Conclusions:
- Alternate-day corticosteroid therapy is a viable strategy to protect growth potential in pediatric renal transplant recipients.
- This regimen offers improved growth outcomes compared to daily corticosteroid administration.
- Pediatric renal transplant recipients with stable renal function should be considered for alternate-day prednisone therapy.
Abstract:
Corticosteroid therapy is probably the main factor inducing stunted growth in pediatric renal transplant recipients. Results of a randomized study in 35 children who received their kidney between 1981 and 1984 are reported. All patients had normal renal function and were taking azathioprine and prednisone to ensure immunosuppression. Eighteen months after transplantation, patients with normal renal biopsy results were randomized to receive further daily corticosteroid therapy (group A) for an additional year or to alternate-day corticosteroid therapy (group B). Chronologic age, bone age, renal function, and previous growth retardation were strictly comparable, in the two groups. During the first year, only prepubertal children in group B exhibited catch-up growth. In children undergoing puberty, annual statural gain was greater in group B (5.6 cm versus 3.2 cm in group A: p less than 0.001). Group A children were switched to alternate-day corticosteroid therapy one year after initiation of the study and exhibited improved growth after this change. No patient had renal function deterioration under alternate-day corticosteroid therapy, throughout the study period. Alternate-day prednisone should be offered to pediatric renal transplant recipients with satisfactory renal function as a mean for protecting growth potential.