Influence of Prolonged Corticosteroid Therapy on the Outcome of Steroid-Responsive Nephrotic Syndrome

Abstract

Eighty-six patients (59 males and 27 females) diagnosed with steroid-responsive nephrotic syndrome during childhood were identified. The patients were 20–40 years of age (mean 27.0 ± 5.0) with a mean follow-up period of 19.5 ± 5.9 years. All patients had been treated with a long-term tapering corticosteroid therapy. Thirty patients had also received a course of cyclophosphamide (2 mg/kg/day for 12 weeks). Sixty-six had achieved sustained remission off corticosteroids, while 20 were still receiving corticosteroids to maintain remission. None of the 86 patients had proteinuria or renal insufficiency at the time of the study. Mean final heights in males and females were similar (–0.51 ± 1.21 and –0.23 ± 1.16 standard deviation score). Mean final height of 20 steroid-dependent patients was significantly less than that of 66 in remission off corticosteroids (p < 0.005). Ten cyclophosphamide-treated patients got married and 9 had at least 1 healthy child. In children with steroid-responsive nephrotic syndrome, the need for corticosteroid therapy to maintain remission may be associated with decreased adult height. Patients who received a 12-week course of cyclophosphamide are likely to be normally fertile as adults.

Atherosclerosis risk factors in young patients formerly treated for idiopathic nephrotic syndrome

“…The reports on delays in growth of children with INS were mainly based on shortterm observations of the patients during steroid therapy [13]. Matsukura et al [14] observed shorter heights in patients with steroid-dependent INS than in those with steroid-sensitive INS. Kitamura [15] found that the final heights of patients with INS treated with GCs during the pubertal body growth spurt were significantly less than the heights of healthy patients.…”

Reduced bone mineral density in adults treated with high-dose corticosteroids for childhood nephrotic syndrome

“…These finding are consistent with known effects of corticosteroids causing growth impairment in adolescents and young adults with frequently relapsing nephrotic syndrome. Matsukura et al found the mean (SD) height Z score of a population of Japanese patients with a mean age of 27.0 years to be −0.43 (1.19), although 20 of the 86 patients were still receiving corticosteroid therapy [20].…”

Growth in boys with idiopathic nephrotic syndrome on long-term cyclosporin and steroid treatment

“…Growth impairment is related to the duration and intensity of steroid therapy, and catch-up growth after the cessation of steroid treatment may be partial and irregular [6][7][8][9][10]. Although steroid regimens used in children with SSNS do not usually have a significant impact on growth [6,[11][12][13][14][15], severe growth retardation has been reported in children with steroiddependent or frequently relapsing nephrotic syndrome, especially in boys [13,14,16]. Studies specifically investigating the linear growth of children with severe SDNS treated with long-term CsA and steroid combination therapy are scarce [17,18].…”