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Growth in children with nephrotic syndrome: a post hoc analysis of the NEPTUNE study
Aesha Maniar1, Debbie S Gipson2, Tammy Brady3
1Division of Nephrology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
Insights
High steroid doses in children with nephrotic syndrome are linked to reduced height. Conversely, rituximab treatment appears to improve height outcomes in these patients.
Area of Science:
- Pediatric Nephrology
- Growth and Development
- Pharmacological Interventions
Background:
- Steroids are a primary treatment for childhood nephrotic syndrome.
- Steroid therapy can lead to adverse effects, including growth suppression.
Purpose of the Study:
- To investigate the longitudinal association between medication exposure and nephrotic syndrome characteristics with height z-score and growth velocity in children.
- To evaluate the impact of cumulative steroid dose and rituximab use on growth in pediatric nephrotic syndrome patients.
Main Methods:
- Analysis of anthropometric measurements from 318 children under 18 enrolled in the Nephrotic Syndrome Study Network (NEPTUNE).
- Longitudinal data were analyzed using adjusted Generalized Estimating Equation regression and linear regression models.
- Key factors assessed included cumulative steroid dose, incident vs. prevalent nephrotic syndrome, and rituximab exposure.
Main Results:
- Greater cumulative steroid exposure was significantly associated with lower height z-scores over time.
- Incident cases of nephrotic syndrome (NS) were also linked to decreased height z-scores compared to prevalent cases.
- Rituximab exposure demonstrated a significant association with higher height z-scores over the study period.
Conclusions:
- Cumulative steroid dose is a significant factor associated with reduced height z-scores in children with nephrotic syndrome.
- Rituximab use shows a positive association with improved height z-scores, suggesting a potential benefit for growth.
- These findings highlight the differential impact of medications on growth in pediatric nephrotic syndrome.
Background:
Steroids, the mainstay of treatment for nephrotic syndrome in children, have multiple adverse effects including growth suppression.
Methods:
Anthropometric measurements in children < 18 years enrolled in the Nephrotic Syndrome Study Network (NEPTUNE) were collected. The longitudinal association of medication exposure and nephrotic syndrome characteristics with height z-score and growth velocity was determined using adjusted Generalized Estimating Equation regression and linear regression.
Results:
A total of 318 children (57.2% males) with a baseline age of 7.64 ± 5.04 years were analyzed. The cumulative steroid dose was 216.4 (IQR 61.5, 652.7) mg/kg (N = 233). Overall, height z-scores were not significantly different at the last follow-up compared to baseline (- 0.13 ± 1.21 vs. - 0.23 ± 1.71, p = 0.21). In models adjusted for age, sex, and eGFR, greater cumulative steroid exposure (β - 7.5 × 10-6, CI - 1.2 × 10-5, - 3 × 10-6, p = 0.001) and incident cases of NS (vs. prevalent) (β - 1.1, CI - 2.22, - 0.11, p = 0.03) were significantly associated with lower height z-scores over time. Rituximab exposure was associated with higher height z-scores (β 0.16, CI 0.04, 0.29, p = 0.01) over time.
Conclusion:
Steroid dose was associated with lower height z-score, while rituximab use was associated with higher height z-score.
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