The Effect of Steroid Therapy on Growth and Bone Density in Children with Nephrotic Syndrome

PURPOSE: Long-term steroid therapy for various glomerular disorders in children has been known to decrease serum Vit D3 level and develop osteomalacia. The aim of this study was to observe the effect of long-term steroid therapy on growth and bone density in children with nephrotic syndrome. METHODS: Bone density of 17 steroid-treated nephrotic syndrome was compared with that of 17 similar aged healthy children by biochemical measurement, bone age and bone mineral density. Serum Vit D3, calcium, phosphorus and alkaline phosphatase were measured and bone mineral content was measured in the lumbar vertebra by dual energy X-ray absorptiometry (HOLOGIC QDR 2000 X-Ray Bone densitometer). RESULTS: There was no significant difference in height ,weight and bone age between the two groups. The mean bone density was significantly lower in children receiving steroid (0.58 +/- 0.04g/cm2) than in the control group (0.65 +/- 0.07g/cm2) (P<0.001). There was no significant correlation between duration of steroid therapy and decrement of bone density. Serum Vit D3 level was significantly lower in the group receiving steroid (16.7 +/- 6.1pg/ml) than in the control group (31.0 +/- 5.8pg/ml) (P<0.001). CONCLUSION: we conclude that alternate-day steroid therapy doesn't affect growth but may lead to decrement of serum Vit D3 level and bone mineral density in children with nephrotic syndrome.

A Study of Menstruation of School Girl in Ansan

Objective: Menstruation is a great part as the procedure for physiological, psychological development and physical growth, and menstrual disorders are very common problems in adolescence period. these problems can be resolved by interview or appropriate education of normal pubertal development. However unlike other developed countries, systematic report or appropriate education for menstruation may not be performed in our country. Therefore. our pediatric department investigated for menstruation of normal pubertal age women as an information educating adolescence. Methods: In cross-sectional study (ex, questionnaire), 4112 junior high and high school girl students (12~18 years old) in Ansan, Kyungki-do were investigated for menarcheal age, menstrual cycle, duration, amount, premenstrual syndrome, dysmenorrhea and relation to family history. Resulta: 1) Mean Menarcheal age was 12.9+/-1.2 years. According to menarcheal age by present age, menarcheal age was younger when present age was young as menarcheal age 11.8+/-0.6 years at 12 years, 13.3+/-1.1 years at 16 years, and 13.7+/-1.1 years at 18 years, respectively (p<0.001). 2) The month during which menarche occurs most frequently was August (14.7%), followed by July, December and January. 3) Considering menstrual cycle, mixed type (regular and irregular cycle) was most common (39.0%), and menstrual cycle became regular after mean 8.8+/-8.4 months. 4) In women having regular menstrual cycle, most women (53.l0%) had menstrual cycles between 26 and 30 days, next was 21~25 days and 31~35 days according to frequency. 5) Menstrual duration was 5~6 days by 49.6% of the women. 6) Premenstrual syndrome was noted in 56.0% of the women, in that 42.5% experienced occasionally and 13.5% always, respectively. 7) Dysmenorrhea was showed in 85.0% of the women. A total of 63.7% of the respondents suffered from dysmenorrhea was unaffected on daily activity as grade l and was needed no medication to relieve pain. Grade 2 (20.5%) was defined that limited daily activity and was needed medication to relieve pain. Grade 3 (0.9%) was defined that inhibited daily activity seriously, and was unimproved by analgesics. 8) The prevalence of dysmenorrhea was 78.0% at 12 years, 85.9% at 15 years and 94.0% at 18 years, respectively. Getting older, frequency of dysmenorrhea was increasing. 9) Dysmenorrhea was experienced for the first time during the first year after the menarche by 65.3% of the women. The amount of menstrual bleeding was significantly correlated to the severity of dysmenorrhea (P<0.001), and dysmenorrhea reported by the women was singificantly correlated to maternal dysmenorrhea (p<0.01) and to sisters with dysmenorrhea (p<0.001). Conclusions: We found that Korean adolescent girls had earlier menarcheal age than past period, and they had many problems for menstruation. This study suggested that it may be needed adolescent education and appropriate treatment of menstrual disorders.