The effects of intermittent doses of adrenocortical steroids on the statural growth of nephrotic children

Fleisher, Daniel S.; McCrory, Wallace W.; Rapoport, Milton

doi:10.1016/s0022-3476(60)80053-4

Cited by 22 publications

(9 citation statements)

References 7 publications

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“…Steroid therapy has been known for many years to reduce height velocity [14] and cause growth retardation in children [12,13,15,16]. Although all children in our study had normal height Z scores at diagnosis, all lost significant height during their years of steroid therapy, averaging an incremental -1.4 Z score loss by the initiation of levamisole.…”

Section: Discussionmentioning

confidence: 64%

“…Not surprisingly, in this cohort, decreased steroid burden During-Lev and Post-Lev led to a beneficial effect on somatic indices of growth, namely, amelioration of the deleterious effects of steroids on linear height and weight gain, as well as improvement in steroid-induced hypertension [12][13][14][15][16]. Steroid therapy has been known for many years to reduce height velocity [14] and cause growth retardation in children [12,13,15,16].…”

Section: Discussionmentioning

confidence: 67%

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Short- and long-term efficacy of levamisole as adjunctive therapy in childhood nephrotic syndrome

et al. 2008

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Many children with steroid-dependent nephrotic syndrome (NS) have significant sequelae despite steroid-sparing therapies. Levamisole may reduce short-term relapse frequency (RF) with minimal side effects. Little data exist, however, as to its long-term effect. To assess both short- and long-term efficacy in NS, RF and cumulative annual steroid burden were quantified in ten consecutive children with steroid-dependent NS treated with levamisole. Data were analyzed for three time periods: 1 year prior to levamisole therapy (Pre-Lev), during 1 year of levamisole therapy (During-Lev), and the year after cessation of all levamisole therapy (Off-Lev). Median RF fell from 6.0 (4.0-9.0) relapses/patient per year Pre-Lev to 0.0 (0.0-4.0) During-Lev (p = 0.002) with 6/10 patients having no relapse and 0.5 (0.0-8.0) Off-Lev (p = 0.01) with 5/10 patients without relapse. Concurrently, cumulative annual steroid burden fell from 6,067 (1,660-8,691) mg/m(2) per year Pre-Lev to 2,920 (782-5,271) During-Lev (p = 0.002) and 716 (0-3,637) Off-Lev (p = 0.002). In 4/5 hypertensive children, blood pressure normalized During-Lev. Somatic indices also improved: height Z scores, which fell from 0.8 (-2.4 to 3.6) at diagnosis to -0.6 (-2.7 to 0.4) Pre-Lev (p = 0.004), remained stable at -0.6 (-3.0 to 0.6) after 1 year of therapy and -0.5 (-2.6 to 0.2) Off-Lev. Height velocity improved from 3.0 (0.3-6.0) cm/year Pre-Lev to 3.7 (0.0-8.0) cm/year During-Lev and 5.4 (0.0-9.1) Off-Lev. We conclude that levamisole is an effective short- and long-term steroid-sparing agent in pediatric NS.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 67%

Short- and long-term efficacy of levamisole as adjunctive therapy in childhood nephrotic syndrome

et al. 2008

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“…It has been reported that short stature may not develop below a steroid dose of 0.75 mg/kg/day (25). In addition, improvement of short stature after discontinuation of steroid treatment has also been reported (26). The approach of administering the minimal dose which would provide remission for a long time in patients with steroid-dependent NS or frequently recurring NS in our center may be thought to have caused to the low rate of short stature in the study.…”

Section: Discussionmentioning

confidence: 65%

Long-term results of children diagnosed with idiopathic nephrotic syndrome; single center experience

Hacıhamdioğlu¹,

Kalman²,

Gök³

2015

Turk Arch Ped

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Aim: The aim of this study was to determine the long-term results of children followed up with a diagnosis of nephrotic syndrome in a single center. Material and Methods:The medical data of 33 patients aged between 6 months and 10 years who were diagnosed with idiopathic nephrotic syndrome in our center between January 2000 and December 2012 and followed up for a period of 2-12 years were reviewed (Gulhane Military Medical Academy Ethics committee, 07.11.2012/10). Results: The mean age of disease onset was 3.2±2.04 years (range: 0.5-10 years) and the mean follow-up period was 6±3.4 years (range: 2-12 years). Thirteen (39.4%) of the study group (or the patients) were female and 20 (60.6%) were male. Twenty seven (1.8%) of the patients were sensitive to steroid and 6 (18.1%) were resistant to steroid. Four (12.1%) of the steroid-resistant patients had steroid-dependent nephrotic syndrome, 5 (15.2%) had frequently relapsing nephrotic syndrome and 18 (54.5%) had rarely relapsing nephrotic syndrome. Histopathological diagnoses of six patients who underwent biopsy because of resistance to steroid were as follows: focal segmental glomerulosclerosis (n=3), C1q nephropathy (n=1), diffuse mesangial proliferation (n=1) and membraneous nephropathy (n=1). Fifteen (45.5%) patients entered into full remission and 2 (6%) patients developed chronic renal failure. Treatment complications including decreased bone mineral density in three patients (9%), short stature in 2 patients (6%) and cataract in 2 patients (6%) developed. Conclusions: Children with nephrotic syndrome carry a risk in terms of short stature, osteoporosis, cataract and renal failure in the long-term follow-up. It was observed that our rates of response to steroid were similar to the literature and the most common histopathological diagnosis was focal segmental glomerulosclerosis in our patients who underwent biopsy because of resistance to steroid. It was thought that multi-center studies should be conducted to demonstrate regional or national differences related with long-term results of childhood nephrotic syndrome. (Türk Ped Arş 2015; 50: 37-44)

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“…The long-term body growth of children with steroid-resistant nephrotic syndrome (NS) has rarely been investigated [1,2], unlike steroid-responsive NS [3][4][5][6][7][8][9]. The factors affecting growth in steroid-resistant NS are not well defined.…”

Section: Introductionmentioning

confidence: 99%

Body growth of children with steroid-resistant nephrotic syndrome

Schärer

Essigmann

Schaefer

1999

Pediatric Nephrology

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Whilst it is assumed that body growth is retarded in children with steroid-resistant nephrotic syndrome (NS), the degree of growth failure and the pathomechanisms involved are poorly understood. We collected serial growth data in 45 children (24 males) with steroid-resistant NS usually from onset to end-stage renal disease (ESRD) during childhood (n=10) or until final height was attained (n=27). Mean follow-up time was 9 (2-19) years. Mean initial standardized height was -0.3+/-1.2 standard deviation scores (SDS). Mean final height was +0.4 SDS in males and -1.0 SDS in females (sex difference not significant). In 16 patients with serum creatinine levels consistently <1.2 mg/dl, mean final height SDS was 0.3 SDS higher than that obtained within 6 months of onset. In contrast, 9 children who entered ESRD lost an average of 1.3 SDS from the initial record to ESRD (P=0.017). In prepubertal patients without renal insufficiency, mean height SDS decreased during corticosteroid treatment by 0.3 SDS, followed by a partial catch-up after discontinuation of treatment; the change from initial to final height SDS was inversely correlated with the total prednisone dose given (r=-0.50, P=0.03). In 16 prepubertal children with serial height and serum protein measurements who were off steroids and maintained normal creatinine levels, mean individual albumin concentrations correlated with the change in height SDS per year (r=0.65, P=0.0006) and in boys with final height (r=0.73, P=0.03). In conclusion, growth in steroid-resistant NS depends on the preservation of renal function, the cumulative dose of steroids applied, and the severity of hypoproteinemia.

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The effects of intermittent doses of adrenocortical steroids on the statural growth of nephrotic children

Cited by 22 publications

References 7 publications

Short- and long-term efficacy of levamisole as adjunctive therapy in childhood nephrotic syndrome

Short- and long-term efficacy of levamisole as adjunctive therapy in childhood nephrotic syndrome

Long-term results of children diagnosed with idiopathic nephrotic syndrome; single center experience

Body growth of children with steroid-resistant nephrotic syndrome

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