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Long-term steroid treatment and growth: a study in steroid-dependent nephrotic syndrome
Jacob Simmonds1, Nicholas Grundy, Richard Trompeter
1Department of Nephrology, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK. simmoj@gosh.nhs.uk
Insights
This study found that prednisolone doses below 0.75 mg/kg/day generally do not negatively impact growth in children with steroid-dependent nephrotic syndrome (SDNS). Higher doses may cause a slight decline, but lower doses allow for catch-up growth.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Pharmacology
Background:
- High-dose steroid therapy is known to impair growth in children.
- The specific threshold for steroid dosage compatible with normal growth in children with steroid-dependent nephrotic syndrome (SDNS) remains unclear.
Purpose of the Study:
- To determine the dosage of prednisolone that allows children with SDNS to maintain normal growth.
- To identify the steroid therapy level at which growth impairment occurs.
Main Methods:
- Studied the growth of 41 children (ages 1.92-13.2 years) with SDNS over a mean follow-up of 4.2 years.
- Calculated height standard deviation score (SDS) and SDS velocity.
- Compared growth parameters with contemporary prednisolone doses (mg/kg/day).
Main Results:
- Mean prednisolone dose was 0.44 mg/kg/day (range 0.06-1.45 mg/kg/day).
- No negative growth effect was observed at prednisolone doses < 0.75 mg/kg/day.
- A small decline in height SDS velocity (-0.14 SDS/year) was noted at doses > 0.75 mg/kg/day.
Conclusions:
- Overall, prednisolone treatment did not adversely affect height SDS in children with SDNS.
- Normal growth was maintained at prednisolone doses up to 0.5-0.75 mg/kg/day.
- Periods of higher steroid use (>0.75 mg/kg/day) showed a slight decline, but lower doses facilitated catch-up growth.
Objective:
High-dose steroid therapy in children is known to impair growth. What is unknown is the level of steroid therapy at which children continue to grow normally. This study was designed to deduce a dosage of prednisolone compatible with normal growth.
Patients And Design:
The growth of 41 children (age 1.92-13.2 years) with steroid-dependent nephrotic syndrome (SDNS) was studied using recordings from clinic visits over the course of their follow-up at Great Ormond Street Hospital (study period range 1.38-8.43 years, mean 4.2 years, total 172 years). The height standard deviation score (SDS) and the SDS velocity between clinics were calculated, and compared to the contemporary dose of prednisolone (converted to an equivalent daily dose when on an alternate day regime).
Results:
The mean dose of prednisolone was 0.44 mg/ kg/day (range 0.06-1.45 mg/kg/day). The mean change in height SDS velocity over the course of recording was -0.02 SDS/year (boys -0.14 SDS/year, girls +0.16 SDS/year). Overall, there was no negative effect on growth seen at doses of prednisolone of less than 0.75 mg/kg/day. At doses higher than 0.75 mg/kg/day, there was a small decline in height SDS velocity (-0.14 SDS/ year).
Conclusions:
Overall, prednisolone treatment in these children was not shown to adversely affect their height SDS. This was true even at doses of prednisolone up to 0.5-0.75 mg/kg/day. There was some decline in height SDS seen during periods of higher steroid use (over 0.75 mg/kg/day), but periods on lower doses allowed for adequate catch up growth.
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