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العنوان
Effects of prolonged use of steroids on the growth of children with nephrotic syndrome /
المؤلف
Kasem, Mohammed Ahmed.
هيئة الاعداد
باحث / محمد أحمد قاسم
مشرف / إسماعيل عبدالعليم حسان
ismail_hassan@med.sohag.edu.eg
مشرف / نجلاء فوزي برعي
مناقش / عماد الدين محمود حماد
مناقش / محمد أحمد محروس
الموضوع
Nephrotic syndrome in children. Steroid hormones Physiological effect. Steroids therapeutic use.
تاريخ النشر
2012.
عدد الصفحات
75 P.:
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
طب الأطفال ، الفترة المحيطة بالولادة وصحة الطفل
تاريخ الإجازة
3/9/2012
مكان الإجازة
جامعة سوهاج - كلية الطب - طب الاطفال
الفهرس
Only 14 pages are availabe for public view

from 85

from 85

Abstract

Idiopathic nephrotic syndrome is the most common glomerulopathy in children. It occurs most commonly in the age group of 2-8 years when the growth rate is at a steady state. Corticosteroids form the main stay of treatment of childhood nephrotic syndrome. However, this line of therapy has serious adverse effects; the most important of them is delayed growth.
While the majority of children with nephrotic syndrome respond to corticosteroids, a large number experience a relapsing course necessitating repeated courses of corticosteroids and putting these patients at high risk of developing growth retardation.
The Aim of this work was to evaluate of the effects of long term corticosteroid use on the growth of children with steroid responsive nephrotic syndrome.
This study was an observational cross sectional study done in Sohag university hospital in the period from April 2011 to April 2012. It included fifty nine nephrotic children, 41 boys and18 girls, aged from 5 to 15years. Additionally, 50 matching healthy children were taken as a control group. Patients who had inadeqate follow up data, steroid resistant nephrotic children and those with impaired kidney functions were excluded from the study.
All the included patients and controls had the following done: Full history, complete clinical examination, accurate height measurement and calculation of its percentile from Egyptian growth chart.
Our study revealed that the final height was below normal centile (below −2.0 of height SDS) in 15% of patients with NS in comparison to 2% of the control group.
We found that most patients who were treated with prednisone during puberty experienced significant growth stunting and the loss of growth percentiles was significantly related to the mean total steroid dose, the mean duration of prednisone use, number of relapses and the mean age of children at time of the study.
Based on this study, children with NS are at risk of permanent growth retardation secondary to steroid treatment, especially those with steroid dependent and/or frequent relapsing NS who need more doses and more prolonged courses of corticosteroids. Recovery of the initial channel growth is possible if steroid treatment is discontinued before puberty allowing time for catch up growth. Longer steroid treatment with higher cumulative doses of prednisone was also the main cause for higher height SDS losses in children with early onset NS.
These findings should guide the management of children with severe steroid-responsive NS. The use of steroid-sparing agents should be considered, in particular during periods of higher risk for growth retardation.
At present, the best way to prevent growth impairment is to avoid an unnecessary prolonged course of treatment with large doses of corticosteroid, to provide adequate intake of calories and proteins, to monitor growth regularly and to try to decrease psychological stress.