effect of long-term steroid therapy on linear growth of nephrotic children

Steroids are still the mainstay of management of nephrotic syndrome [NS]. It was shown that steroids could impair growth and development of children. However, other clinical studies have shown conflicting results. Hospital records of 147 children with diagnosis of NS who were followed during 1988-2008 are reviewed relating to height measurements. All patients were treated with prednisolone and had been followed for at least five years. Height measures were transformed into standard deviation score [SDS]. Information on dose and duration of prednisolone therapy, histological findings of biopsy as well as concomitant use of steroid-sparing agents [SSA] were also analyzed. Mean age at onset of NS was 5.94 years and at last follow-up visit 15.08 years. All patients had normal renal function during entire duration of the study. Analysis of the whole population did not show any significant alterations in the height SDS [Ht[SDS]] between the first and the last follow-up visit [P=0.5; -0.76 +/- 2.0 vs. -0.89 +/- 2.05 respectively]. The patients were divided into two subgroups. Subgroup A, which achieved growth improvement, was composed of 62 children [initial [Ht[SDS]] -1.63; final [Ht[SDS]] -0.08; P<0.001] and subgroup B, that showed growth retardation, included 85 children [initial [Ht[SDS]] -0.13; final [Ht[SDS]] -1.59; P<0.001]. No statistically significant retardation of linear growth was observed in the study population as a group following treatment with prednisolone according to the guidelines of ISKDC. Although about 62 subjects had growth retardation, children treated with prednisolone were not different from those who had increased growth

estimation of steroid responsiveness of idiopathic nephrotic syndrome in Iranian children

Idiopathic Nephrotic syndrome [INS] is the most common form of nephrotic syndrome [NS] in children with the potential of progression to end stage renal disease [ESRD]. INS is steroid-responsive in most children, but not all patients respond to it. The aim of this study was to determine the rate of steroid responsiveness in children with INS that referred to Children's Medical Center since 1995 to 2007. In as a cross sectional study, the medical records of all children with INS aged 1 to 15 years who were referred to our referral hospital was reviewed. All patients with onset of disease less than 1 year of age, spontaneous remission, secondary forms of NS associated with systemic diseases, and follow up duration of less than 12 months were excluded from the study. Patients were categorized into 6 groups: Group 1 needed biopsy prior to any treatment, group 2 non-relapsing NS, group 3 infrequently relapsing NS, Group 4 frequently relapsing NS, group 5 steroid dependent NS and group 6 steroid resistant NS. A total of 238 patients were enrolled in the study. Kidney biopsy was performed in 79 cases. Minimal change lesion [MCL] was the most common [36.7%] pathological diagnosis. Steroid responsiveness was found in 81.5% of all cases including: 96% of MCL [consisting of biopsy proven cases and presumed ones], 32% of focal and segmental glomerulosclerosis, 73% of diffuse mesangial proliferation and 58% of membranoproliferative glomerulonephritis patients. During minimal follow up period of 12 months, there were 194 patients in remission, 32 patients with active NS, and 12 patients in ESRD. Our study results showed that 81.5% of all patients, 96.2% of MCL and 32% of FSGS patients initially responded to steroid therapy