Effect of glucocorticoids on growth and bone mineral density in children with nephrotic syndrome

Glucocorticosteroids (GCs) are the first-line treatment for idiopathic nephrotic syndrome (NS), but prolonged administration interferes with growth and bone mineralization. We conducted a retrospective study to analyze the long-term impact of prednisone on growth and bone mineral density (BMD) in children with NS. Data from children with NS followed during almost 10 years were analyzed. Height and spine BMD values were converted to Z-scores (standard deviation [SD]). The mean cumulative dose of GCs received was calculated and correlated to patient's growth and spine BMD using linear regression and subgroup analysis. We included 30 patients diagnosed at 3.7 years old (interquartile range (IQR) 2.6-4.8) and followed over 9.8 years (IQR 6.6-11.7). The one half of NS patients was steroid sensitive and one half dependent or resistant. The median cumulative dose of GCs received was 0.27 mg/kg/day (IQR 0.18-0.35). Growth and spine BMD were both negatively associated with the cumulative dose of GCs (P=0.001 and P=0.037, respectively). Final height Z-scores were significantly lower in patients receiving >0.2 mg/kg/day GCs (P=0.001). No difference was observed in spine BMD between subgroups

Alternatives to steroid treatment of steroid-sensitive nephrotic syndrome in childhood

Background. Despite being an orphan disease, idiopathic nephrotic syndrome in childhood is the most frequent glomerular disease in this age group. Nephrotic syndrome in children is a heterogeneous disease and in order to assess the individual facets of the disease a classification using the following criteria are helpful: etiology, age at onset, histology and responsiveness to initial standard treatment with glucocorticoids. Most important is the differentiation between steroid-sensitive (SSNS) and steroid-resistant nephrotic syndromes (SRNS) because SRNS is a risk factor for developing end-stage renal disease. Conclusion. A high cumulative dosage of glucocorticoids and prolonged intake do not seem to impact on the risk of relapse. In order to avoid short and long-term glucocorticoid-associated side effects alternative treatment options should be kept in mind when planning individual treatment options, especially with mycophenolate mofetil, calcineurin inhibitors and rituximab in patients with frequently relapsing disease. Genetic diagnostics aremandatory in patients with SRNS; however, immunosuppressive treatment in children with genetic forms of nephrotic syndrome rarely leads to remission