Follow-up of linear growth of body height in children with nephrotic syndrome

Background and Purpose: Steroid treatment is a mainstay in the management of nephrotic syndrome, but has the potential to impair growth and development of children. This study evaluated the effects of steroid regimens on linear growth of body height in children with nephrotic syndrome. Methods: Hospital records of height measurements were reviewed for a selected cohort of 50 children with nephrotic syndrome. Patient data were obtained from disease onset until follow-up of at least 32 months. Information on dosage of prednisolone and immunosuppressive agents was also analyzed. Results: The mean age at presentation was 6.8 years, and the mean age at final consultation was 10 years. Around one-half and one-third of children received the immunosuppressive agents cyclophosphamide and chlorambucil, respectively, in combination with prednisolone. Prednisolone treatment was associated with progressive reduction in height standard deviation score, which became statistically significant after 3 years (p<0.05). At year 3, patients receiving immunosuppressive agents in combination with prednisolone had significantly higher mean height standard deviation score values compared with prednisolone-only patients. There was a significant (p<0.05) inverse correlation between total prednisolone dose and percentile of body length during year 3 of treatment. Conclusions: Prednisolone was associated with impairment of growth in body height, in a dose-dependent fashion. Combined administration of immunosuppressive agents significantly reduced this effect and appears to have a therapeutic role in this setting, particularly when long-term treatment is required.