Ahvaz Jundishapur University of Medical Sciences, Chronic Renal Failure Research Center, Ahvaz, Iran.
Ahvaz Jundishapur University of Medical Sciences, Diabetes Research Center, Ahvaz, Iran.
J Pediatr (Rio J). 2020 Jan-Feb;96(1):117-124. doi: 10.1016/j.jped.2018.07.014. Epub 2018 Sep 18.
This study aims at determining the relationship between prednisolone cumulative dose and linear growth in pre-pubertal children with idiopathic nephrotic syndrome.
This cross-sectional study was conducted on all children with idiopathic nephrotic syndrome registered to the pediatric nephrology department at the main referral children's hospital in Southwestern Iran. Inclusion criteria included age (males <12 years; females <10 years), >6 months of use, and the minimum prednisolone cumulative dose of 152mg/kg. The exclusion criteria were individuals who had entered puberty or had other diseases affecting linear growth. Based on the prednisolone cumulative dose of ≥550mg/kg (four or more relapses), the children were divided into two groups. All data regarding age, height, and weight at disease onset and the last visit, bone age, and the parents' height were collected. Secondary variables including mid-parental target height and predicted adult height were also calculated. Height data were compared between the different rates of relapse.
A total of 97 children (68% male) were enrolled. Their post-treatment mean height Z-score was less than that obtained before treatment (-0.584 vs. -0.158; p=0.001). Subjects with higher prednisolone cumulative doses were found to have more reduction in height Z-score (p=0.001). Post-treatment height prediction also showed less growth potential compared to pre-treatment target height (p=0.006). Thirty-three children (34.4%) had four or more relapses, among whom more mean-height Z-score decreases were found compared to those with less-frequent relapses (-0.84 vs. -0.28; p=0.04).
This study showed the negative effect of cumulative dosages of prednisolone on linear growth, which was greater in children with four or more relapses.
本研究旨在确定泼尼松累积剂量与特发性肾病综合征青春期前儿童线性生长之间的关系。
本横断面研究在伊朗西南部主要转诊儿童医院儿科肾病科登记的所有特发性肾病综合征患儿中进行。纳入标准包括年龄（男性<12 岁；女性<10 岁）、>6 个月的使用期和最低 152mg/kg 的泼尼松累积剂量。排除标准为进入青春期或患有其他影响线性生长的疾病的个体。根据泼尼松累积剂量≥550mg/kg（≥4 次复发），将儿童分为两组。收集所有与疾病发作和最后一次就诊时的年龄、身高和体重、骨龄以及父母身高相关的数据。还计算了次要变量，包括中亲身高目标和预测成人身高。比较不同复发率之间的身高数据。
共纳入 97 名儿童（68%为男性）。他们治疗后的平均身高 Z 评分低于治疗前（-0.584 比-0.158；p=0.001）。发现泼尼松累积剂量较高的患者身高 Z 评分下降幅度更大（p=0.001）。治疗后身高预测也显示与治疗前目标身高相比生长潜力较低（p=0.006）。33 名儿童（34.4%）有≥4 次复发，其中与复发频率较低的儿童相比，身高 Z 评分下降幅度更大（-0.84 比-0.28；p=0.04）。
本研究表明，泼尼松累积剂量对线性生长有负面影响，在有≥4 次复发的儿童中影响更大。
