Glucocorticoids in renal disease. Theoretical basis, consequences and efficacy of use in the pediatric patient.

Glucocorticoids have been used extensively in the management of patients with renal disease. The beneficial effect of glucocorticoids on renal disease is probably mediated via the suppression of immune function, although some evidence exists for a direct influence of corticosteroids on glomerular function. A myriad of glucocorticoid complications have been reported, including: skin, eye, bone, blood and adipose tissue changes, as well as growth retardation, hypertension and an increased susceptibility to infection. A review of the efficacy of glucocorticoid use demonstrates benefit in a small number of glomerulonephritides (minimal change nephrotic syndrome, systemic lupus erythematosus, polyarteritis nodosa and renal transplantation). Since being introduced in the early 1950s, glucocorticoids have proven to be of limited usefulness in the treatment of glomerulonephritis.