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Influence of steroid medication on bone mineral density in children with nephrotic syndrome
Insights
Children with idiopathic nephrotic syndrome treated with high-dose steroids showed reduced bone mineral density (BMD). Cumulative steroid dose, not cyclophosphamide, correlated with decreased bone density, impacting trabecular, cortical, and total bone.
Area of Science:
- Pediatric Endocrinology
- Nephrology
- Bone Metabolism
Background:
- Idiopathic nephrotic syndrome (INS) is a significant pediatric kidney disease.
- Long-term steroid therapy is standard for INS but may affect bone health.
- Understanding steroid-induced bone density changes in children is crucial.
Purpose of the Study:
- To investigate bone mineral density (BMD) in children with INS.
- To assess the impact of cumulative steroid dose and cyclophosphamide on BMD.
- To compare BMD in INS patients with healthy controls.
Main Methods:
- Peripheral quantitative computed tomography (pQCT) was used to measure BMD.
- Trabecular (TBD), cortical (CBD), and total bone density (BD) were assessed.
- Patients were grouped by cumulative steroid dose and cyclophosphamide use.
Main Results:
- Children with INS exhibited decreased BD, CBD, and TBD compared to controls.
- BD and CBD showed an inverse correlation with cumulative steroid dose.
- Significant BMD reduction was observed in patients with high cumulative steroid doses, particularly those also treated with cyclophosphamide.
Conclusions:
- High cumulative steroid doses are associated with reduced bone mineral density in children with INS.
- Steroid toxicity, rather than cyclophosphamide, appears to be the primary factor in bone density reduction.
- Further research into bone protective strategies for INS patients is warranted.
Abstract:
Bone mineral density (BMD) was studied in 26 children with idiopathic nephrotic syndrome and in age- and sex-matched healthy controls. BMD was selectively measured in trabecular (TBD), cortical (CBD) and total bone (BD) using peripheral quantitative computed tomography. Patients showed a decrease in BD, CBD and TBD. BD and CBD were inversely correlated with the cumulative dose of steroid treatment. Of the 26 patients with high cumulative doses of steroid, 16 were also treated with cyclophosphamide. In this group BD and CBD were decreased significantly compared with the children with a low cumulative steroid dose only. Compared with controls for each subgroup, significant decreases in BD, CBD and TBD were found in the group with high cumulative doses of steroids only. The higher cumulative steroid dose and the initial steroid toxicity which made cytotoxic therapy necessary, rather than cyclophosphamide itself, may be responsible for these findings.