Growth Delay in Steroid Sensitive Nephrotic Patients


ABSTRACT:BACKGROUND:Growth in patients with idiopathic nephrotic syndrome (INS) is influenced by several factors, they suffer the influence of the disease itself as long as there is proteinuria, caused by the increase of the glomerular permeability and leading to hypoproteinemia. The effects of the glucocorticoid treatment, which alters growth by a direct action on the growth cartilage, or via disturbances of growth factors. In this study we assess the effect of nephrotic syndrome, it's relapse rate and it's treatment (i.e. steroid), in the statural growth of steroid sensitive nephrotic patients.METHODS:A Prospective study of 110 steroid responsive nephrotic patients collected from AL- Kadhemia Teaching Hospital, Central Child Teaching Hospital, Child Wellfaire Teaching Hospital & AL-Karama Teaching Hospital. The study started from first of June 2005 to first of June 2006. Data collected as following: age, sex, date of first diagnosis, duration of disease, number of relapses per year, measurement of the height, weight and body mass index and sign of steroid toxicity.RESULTS:Total number of our patients were 110, 74(67.3%) were males and 36(32.7%) were females, with male to female ratio of 2:1. The age of our patients range from 2-18 years with a mean of 7.9+3.8 years.Thirty-one (28.2%) of them were with height below 3rd percentile for their age, 24(77.4%) were males and 7(22.6%) were females.Twenty- five (22.7%) patients were at pubertal age. Eighteen (72%) were males and 7(28%) were females, and 17(68%) of them have height below 3rd percentile.Seventy –six (69%) patients have their onset of the disease at age between 2 and 6 years. Forty-six (41.8%) of patients have disease duration of less than 3 years, 3 (6.5%) of them were have height below 3rd percentile, 46(41.8%) with duration of 3-6years, 14(30.4%) them were have height below 3rd percentile and 18(16.4%) with duration of more than 6 years, 14(77.8%) of them have height below 3rd percentile.Fifty-five (50%) patients had frequent relapses, twenty-seven (49.1%) of them have height below 3rd percentile, compared to 4(7.3%) of those with infrequent relapse had height below 3rd percentile.Forty-seven (42.7%) patients show sign of steroid toxicity(cushigoid facial appearance with or with out hypertention,obesity,hirsutism..etc) 25(53.2%) of them have height below 3rd percentile, compared to 6(9.5%) of those who have no sign of toxicity.CONCLUSSION:Nephrotic syndrome is a potentially chronic disease with patients suffering a relapsing course and being at risk of frequent courses of prednisolone therapy with increase the risk of growth delay especially in patients reaching pubertal age and still taking steroid therapy.