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Reversibility of corticosteroid-associated cataracts in children with the nephrotic syndrome
Insights
Oral corticosteroid therapy in children with nephrotic syndrome can lead to posterior subcapsular cataracts. Some cataracts may regress, and Cushingoid signs indicate increased sensitivity to steroids.
Area of Science:
- Ophthalmology
- Pediatrics
- Endocrinology
Background:
- Oral corticosteroid therapy is a cornerstone in managing childhood nephrotic syndrome.
- Posterior subcapsular cataracts (PSCs) are a known potential side effect of corticosteroid use.
- The specific relationship between corticosteroid treatment and PSC development/regression in nephrotic children requires further elucidation.
Purpose of the Study:
- To investigate the association between oral corticosteroid therapy and the incidence and regression of posterior subcapsular cataracts in children with nephrotic syndrome.
- To identify factors correlating with PSC formation in this patient population.
Main Methods:
- Ophthalmic reexamination of 39 children with nephrotic syndrome.
- Assessment of corticosteroid dosage relative to patient weight.
- Evaluation of correlation between PSCs and age at onset, corticosteroid dosage/duration, renal biopsy findings, and clinical manifestations.
Main Results:
- Six children developed posterior subcapsular cataracts (PSCs) within an average of 16 months.
- Nine patients experienced complete regression of their PSCs.
- No correlation was found between PSCs and age at nephrotic syndrome onset, corticosteroid dose/duration, or renal biopsy results.
- Cushingoid manifestations were significantly more prevalent in children with PSCs.
Conclusions:
- Posterior subcapsular cataracts can develop and regress during oral corticosteroid therapy for nephrotic syndrome in children.
- Cushingoid features may indicate heightened sensitivity to corticosteroid effects, potentially increasing cataract risk.
- Individual sensitivity to corticosteroids, rather than solely dose or duration, might play a crucial role in PSC development.
Abstract:
We reexamined the eyes of 39 nephrotic children to investigate further the relationship between oral corticosteroid therapy and posterior subcapsular cataract formation. The corticosteroid dosage was proportional to each patient's weight. Six children had posterior subcapsular cataracts an average of 16 months after the first examination. Nine patients had complete regression of their posterior subcapsular cataracts. We found no correlation between the age at onset of the nephrotic syndrome, the dosage or duration of corticosteroid therapy, or the renal biopsy findings and posterior subcapsular cataract formation. Cushingoid manifestations were significantly more common in the patients with posterior subcapsular cataracts. These patients may be more sensitive to the effects of corticosteroids than those who never had cataracts and those whose cataracts regressed.