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[Clinical study on growth impairment induced by oral glucocorticoids based on FGF23/Klotho homeostasis observations]
Shuai Tang1, Yang Yang1, Xiang Li1
1Pediatric Medical College, Henan University of Chinese Medicine, Zhengzhou 450000, China.
Insights
Long-term glucocorticoid (GC) therapy in children with primary nephrotic syndrome (PNS) disrupts FGF23/Klotho homeostasis, leading to impaired growth. This study observed a higher FGF23/Klotho ratio in GC-treated children, correlating with reduced height and bone age growth rates.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Biochemistry
Context:
- Children with primary nephrotic syndrome (PNS) often require long-term glucocorticoid (GC) therapy.
- Growth impairment is a significant concern in children undergoing GC treatment.
- The FGF23/Klotho axis plays a role in mineral metabolism and potentially growth regulation.
Purpose:
- To investigate the correlation between growth impairment and the FGF23/Klotho ratio in children with PNS receiving long-term oral GC therapy.
- To compare FGF23/Klotho ratios and growth parameters between children with PNS on GC therapy, those off GC therapy, and healthy controls.
Summary:
- A prospective study compared 56 children with PNS (GC group n=29, non-GC group n=27) and 29 healthy controls.
- The GC group showed a significantly higher FGF23/Klotho ratio and lower height/bone age growth rates within 6 months compared to the non-GC group.
- Significant negative correlations were found between the FGF23/Klotho ratio and growth rates in children with PNS.
Impact:
- Disturbance in FGF23/Klotho homeostasis is identified as a contributing mechanism to GC-induced growth impairment in children with PNS.
- Findings suggest potential therapeutic targets for mitigating growth deficits in pediatric nephrotic syndrome patients on GC therapy.
- Highlights the importance of monitoring FGF23/Klotho levels in pediatric patients receiving long-term GC treatment.
Objectives:
To observe the correlation between growth impairment induced by long-term oral glucocorticoids (GC) therapy and the ratio of FGF23/Klotho in children with primary nephrotic syndrome (PNS).
Methods:
A prospective study was conducted on 56 children with GC-sensitive PNS who had discontinued GC therapy for more than 3 months and revisited the Department of Pediatrics of the First Affiliated Hospital of Henan University of Traditional Chinese Medicine between June 2022 and December 2022. After monitoring qualitative and quantitative urine protein levels upon admission, the children with proteinuria relapse were treated with GC (GC group; n=29), while those without relapse did not receive GC treatment (non-GC group; n=27). In addition, 29 healthy children aged 3 to prepuberty were selected as the control group. Height, bone age, growth rate, and the FGF23/Klotho ratio were compared among the groups. The correlations of the FGF23/Klotho ratio with height, bone age, and growth rate were analyzed.
Results:
The FGF23/Klotho ratio in the GC group was significantly higher than that in the non-GC group after 1 month of GC therapy (P<0.05), and the height and bone age growth rates within 6 months were lower than those in the non-GC group (P<0.05). Correlation analysis showed significant negative correlations between the FGF23/Klotho ratio after 1 month of treatment and the growth rates of height and bone age within 6 months in children with PNS (r=-0.356 and -0.436, respectively; P<0.05).
Conclusions:
The disturbance in FGF23/Klotho homeostasis is one of the mechanisms underlying the growth impairment caused by long-term oral GC therapy.
