Article Text

PDF
Long-term steroid treatment and growth: a study in steroid-dependent nephrotic syndrome
  1. Jacob Simmonds,
  2. Nicholas Grundy,
  3. Richard Trompeter,
  4. Kjell Tullus
  1. Department of Nephrology, Great Ormond Street Hospital for Children, Great Ormond Street, London, UK
  1. Correspondence to Dr Jacob Simmonds, 6th Floor, Old Nurses' Home, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK; simmoj{at}gosh.nhs.uk

Abstract

Objective High-dose steroid therapy in children is known to impair growth. What is unknown is the level of steroid therapy at which children continue to grow normally. This study was designed to deduce a dosage of prednisolone compatible with normal growth.

Patients and design The growth of 41 children (age 1.92–13.2 years) with steroid-dependent nephrotic syndrome (SDNS) was studied using recordings from clinic visits over the course of their follow-up at Great Ormond Street Hospital (study period range 1.38–8.43 years, mean 4.2 years, total 172 years). The height standard deviation score (SDS) and the SDS velocity between clinics were calculated, and compared to the contemporary dose of prednisolone (converted to an equivalent daily dose when on an alternate day regime).

Results The mean dose of prednisolone was 0.44 mg/ kg/day (range 0.06–1.45 mg/kg/day). The mean change in height SDS velocity over the course of recording was −0.02 SDS/year (boys −0.14 SDS/year, girls +0.16 SDS/year). Overall, there was no negative effect on growth seen at doses of prednisolone of less than 0.75 mg/kg/day. At doses higher than 0.75 mg/kg/day, there was a small decline in height SDS velocity (−0.14 SDS/ year).

Conclusions Overall, prednisolone treatment in these children was not shown to adversely affect their height SDS. This was true even at doses of prednisolone up to 0.5–0.75 mg/kg/day. There was some decline in height SDS seen during periods of higher steroid use (over 0.75 mg/kg/day), but periods on lower doses allowed for adequate catch up growth.

Statistics from Altmetric.com

Footnotes

  • Funding This study was funded by the Department of Nephrology, Great Ormond Street Hospital.

  • Competing interests None.

  • Ethics approval The study was registered and approved by the research ethics committee of The Institute of Child Health.

  • Provenance and peer reviewed Not commissioned; externally peer reviewed.

  • The studied was registered and approved by the research ethics committee of The Institute of Child Health.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.