Growth Suppression in Children with Frequently-Relasing/Steroid-Dependent Nephrotic Syndrome

Nova Southeastern University, Davie, Florida, USA

Objective. Growth velocity rate (GR) in children with steroid-sensitive nephrotic syndrome (SSNS) is adversely affected by steroid dose and duration of therapy. Prediction of long term growth-suppression is desired. The purpose of this study was to characterize the growth of children with SSNS during the first year after diagnosis, in an attempt identify a predictor of growth suppression, in two geographically distinct settings. Methods. Two cohorts of pre-pubertal children (≤ 10 years of age) with SSNS treated with prednisone based on modified ISKDC protocol, 4-6 wks daily and 4-6 wks alternate day dosing, followed for at least a year, in two different settings (Romania – group 1, and USA/JDCH – group 2). Variables: relapse pattern, GR and height (Ht) SDS at 6 and 12 months. Student’s t-test where applicable, significance if pResults. 29 children with SSNS (age : 3.9±2.4 in gr 1, 4.3±1.5 in gr 2), had complete data at 12 mos, 25 at 6 mos. 14 in group 1 and 15 in group 2, 20 infrequent relapsers (IR), 9 frequent relapsing (FR)/steroid-dependent (SD) disease course. 16 Caucasians, 9 African-Americans, 4 Hispanics. Due to small sample size, in both groups combined, during the second 6-month period, GR was slower in FR/SD vs IR: 4.4±2.5 vs 8.0±4.9 cm/yr (p=0.0003), with ΔHt SDS at 1 yr of -0.5±0.7 and 0.5±0.5, respectively (p=0.003, n=29). No geographical or racial differences. Conclusion. Use of steroid-sparing agents needs to be considered if by one year after diagnosis catch-up growth is not seen in patients with FR/SD SSNS.