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Assessment of Linear Growth in Children with Idiopathic Nephrotic Syndrome
Mohammed Shoheb Aathif Shaik1, Om Prakash Mishra2, Priyanka Dua1
1Division of Pediatric Nephrology, Department of Pediatrics, Heritage Institute of Medical Sciences, Varanasi, India.
Insights
Corticosteroid therapy for idiopathic nephrotic syndrome can lead to short stature, particularly with earlier disease onset and longer treatment duration. Monitoring linear growth is crucial in pediatric patients undergoing steroid treatment.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Growth and Development
Background:
- Idiopathic nephrotic syndrome (INS) is a common kidney disorder in children.
- Corticosteroid therapy is the mainstay treatment for INS, but can have significant side effects.
- Linear growth impairment is a recognized complication of long-term corticosteroid use.
Purpose of the Study:
- To evaluate the impact of corticosteroid therapy on linear growth in children with various forms of idiopathic nephrotic syndrome.
- To identify factors influencing growth outcomes in patients with INS treated with steroids.
Main Methods:
- A cohort of 245 pediatric patients (aged 1-18 years) with different subtypes of INS were analyzed.
- Data collected included height Z-scores before and after therapy, cumulative prednisolone dose, and steroid-related side effects.
- Statistical analysis correlated disease onset age, therapy duration, and steroid dose with changes in height Z-scores.
Main Results:
- Nearly 40% of patients developed short stature (height Z-score <-2) after corticosteroid therapy.
- A significant reduction in median height Z-score was observed post-treatment (-1.9 vs. -2.3).
- Higher cumulative steroid doses and longer therapy durations were associated with decreased height velocity and significant negative changes in height Z-scores.
Conclusions:
- Younger age at disease onset and longer duration of steroid therapy are significantly associated with impaired linear growth in pediatric INS.
- These findings highlight the importance of monitoring growth and optimizing steroid regimens in children with nephrotic syndrome.
Objectives:
To assess the linear growth in patients with idiopathic nephrotic syndrome receiving corticosteroid therapy.
Methods:
Two hundred forty-five cases, aged 1-18 y of both gender [53 - first episode nephrotic syndrome (FENS), 50 - infrequent relapsing (IRNS), 68 - frequent relapsing (FRNS), 46 - steroid dependent (SDNS) and 28 - steroid resistant (SRNS)] were included. Height Z-score, cumulative dose of prednisolone and steroid-related side-effects were recorded.
Results:
Median age at onset of disease was 3.8 y [interquartile range (IQR) 3-7] and median duration of follow-up was 4 mo (IQR 3, 10). Overall, 97 cases (39.5%) showed short stature (height Z-score <-2) after therapy; 27 had short stature before and 70 (28.5%) new cases (20 IRNS + 31 FRNS + 17 SDNS + 2 SRNS) developed after treatment. Median height Z-score showed significant reduction (-1.9 vs. -2.3, P <0.001) after therapy. Cumulative steroid dose (mg/m2) significantly decreased the height velocity in 50 cases (31 FRNS + 17 SDNS + 2 SRNS), who received steroid over prolonged period (r = -0.322, p = 0.023). Age at onset of disease (r = -0.328, p = 0.020) and duration of steroid therapy (r = -0.338, p = 0.016) significantly correlated with change in height Z-scores.
Conclusions:
Younger age of onset of disease and duration of steroid therapy had significant relationship with linear growth.
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