Effect of prednisolone on linear growth in children with nephrotic syndrome
Ehsan Valavi1, Majid Aminzadeh2, Parisa Amouri1
1Ahvaz Jundishapur University of Medical Sciences, Chronic Renal Failure Research Center, Ahvaz, Iran.
Insights
High cumulative doses of prednisolone negatively impact linear growth in children with idiopathic nephrotic syndrome, especially those with frequent relapses.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Growth and Development
Background:
- Idiopathic nephrotic syndrome (INS) is a common kidney disease in children.
- Steroid therapy, particularly prednisolone, is the cornerstone of INS treatment.
- Long-term steroid use can affect linear growth in children.
Purpose of the Study:
- To investigate the relationship between cumulative prednisolone dose and linear growth in pre-pubertal children with INS.
- To assess the impact of treatment on height Z-scores and growth potential.
- To compare growth outcomes based on relapse frequency.
Main Methods:
- Cross-sectional study of 97 pre-pubertal children with INS.
- Inclusion criteria: age, duration of use, and minimum cumulative prednisolone dose.
- Exclusion criteria: puberty or other growth-affecting diseases.
- Children divided into groups based on cumulative dose (≥550mg/kg) and relapse frequency.
- Data collected: age, height, weight, bone age, parental height, mid-parental target height, and predicted adult height.
Main Results:
- Post-treatment mean height Z-score was significantly lower than pre-treatment (-0.584 vs. -0.158; p=0.001).
- Higher cumulative prednisolone doses correlated with greater height Z-score reduction (p=0.001).
- Predicted adult height was less than pre-treatment target height (p=0.006).
- Children with ≥4 relapses showed greater mean height Z-score decreases (-0.84 vs. -0.28; p=0.04).
Conclusions:
- Cumulative prednisolone dosage negatively affects linear growth in children with INS.
- The negative impact on growth is more pronounced in children experiencing four or more relapses.
- This highlights the importance of monitoring growth in children undergoing long-term steroid treatment for INS.
Objective:
This study aims at determining the relationship between prednisolone cumulative dose and linear growth in pre-pubertal children with idiopathic nephrotic syndrome.
Method:
This cross-sectional study was conducted on all children with idiopathic nephrotic syndrome registered to the pediatric nephrology department at the main referral children's hospital in Southwestern Iran. Inclusion criteria included age (males <12 years; females <10 years), >6 months of use, and the minimum prednisolone cumulative dose of 152mg/kg. The exclusion criteria were individuals who had entered puberty or had other diseases affecting linear growth. Based on the prednisolone cumulative dose of ≥550mg/kg (four or more relapses), the children were divided into two groups. All data regarding age, height, and weight at disease onset and the last visit, bone age, and the parents' height were collected. Secondary variables including mid-parental target height and predicted adult height were also calculated. Height data were compared between the different rates of relapse.
Results:
A total of 97 children (68% male) were enrolled. Their post-treatment mean height Z-score was less than that obtained before treatment (-0.584 vs. -0.158; p=0.001). Subjects with higher prednisolone cumulative doses were found to have more reduction in height Z-score (p=0.001). Post-treatment height prediction also showed less growth potential compared to pre-treatment target height (p=0.006). Thirty-three children (34.4%) had four or more relapses, among whom more mean-height Z-score decreases were found compared to those with less-frequent relapses (-0.84 vs. -0.28; p=0.04).
Conclusion:
This study showed the negative effect of cumulative dosages of prednisolone on linear growth, which was greater in children with four or more relapses.
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