Relation between total steroid dose and height growth rate in children with nephrotic syndrome

Abstract

Purpose: Among the side effects of steroids, low growth is a problem of particular concern for children in the growth phase. Steroids are currently the first choice for treatment of nephrotic syndrome, but recently it has become possible to reduce or discontinue steroids in a growing number of steroid-dependent patients by combining with cyclosporine or various other immunosuppressants. At our hospital, combined use of immunosuppressants is currently adopted in cases of high steroid dependence with recurrence after repeated administration of Predonisolone (PSL) at 1 mg/kg every other day; however, we wanted to clarify whether or not this standard was appropriate from considerations of growth.
Methods: The relationship between height growth rate and total steroid dose over one year was investigated in children with nephrosis in our hospital. The subjects were 54 children (including 5 confirmed cases of FSGS) for whom we had growth records for the past year, from among the 82 children with idiopathic nephrotic syndrome under management at our hospital as of August 2008. A retrospective investigation was conducted of the relation between rate of increase in height and total steroid dose for the one year from August 1, 2007 to July 31, 2008.
Conclusion: The rate of increase in height tended to decline as the total steroid dose increased. However, the possibility was indicated that when the dose is small there is little effect on the height increase rate. At our hospital today, we consider a PSL dose of 1 mg/kg ADT (=0.5mg/kg/day) or more to be reasonable as a standard for combined use of an immunosuppressant.