Corticosteroids and obesity in steroid-sensitive and steroid-resistant nephrotic syndrome

Main Article Content

Nina Lestari
Neti Nurani
Madarina Julia

Abstract

Background Children with nephrotic syndrome need high-dose corticosteroids to achieve remission. Studies have estimated a 35-43% risk of obesity in these patients after corticosteroid treatment.

Objective To determine the prevalence of obesity in children who received corticosteroids for nephrotic syndrome, and to compare the risk of obesity in children with steroid-sensitive nephrotic syndrome (SSNS) and steroid-resistant nephrotic syndrome (SRNS).

Methods We performed a retrospective cohort study in 50 children with SSNS or SRNS who received corticosteroid treatment. Obesity was defined to be a BMI-for-age Z-score above +2.0 SD, according to the WHO Growth Reference 2007. Central obesity was defined to be a waist-to-height ratio > 0.50.

Results The overall prevalence of obesity was 22%, with 29% and 14% in the SSNS and SRNS groups, respectively. The overall prevalence of central obesity was 50%, with 54% and 46% in the SSNS and SRNS groups, respectively. The cumulative steroid doses in this study were not significantly different between the SSNS and SRNS groups. There were also no significant differences between groups for risk of obesity (RR 2.53; 95%CI 0.58 to 10.99) or central obesity (RR 1.39; 95%CI 0.45 to 4.25).

Conclusion In children with nephrotic syndrome who received corticosteroids, the prevalence of obesity is 22% and of central obesity is 50%. In a comparison of SSNS and SRNS groups, cumulative steroid dose as well as risks of obesity and central obesity do not significantly differ between groups.

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1.
Lestari N, Nurani N, Julia M. Corticosteroids and obesity in steroid-sensitive and steroid-resistant nephrotic syndrome. PI [Internet]. 31Jul.2015 [cited 24Apr.2019];55(4):194-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/21
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References

1. Behrman RE, Kliegman RM, Jenson HB. Nephrotic syndrome. In: Nelson textbook of pediatrics. 17th ed. Philadelphia: Saunders; 2004. p. 1753-8.
2. Gipson DS, Massengill SF, Yao L, Nagaraj S, Smoyer WE, Mahan JD, et al. Management of childhood onset nephrotic syndrome. Pediatrics. 2009;124:747-57.
3. Eddy AA, Symons JM. Nephrotic syndrome in childhood. Lancet. 2003;362:629-39.
4. Wirya IW. Penelitian beberapa aspek klinis dan patologi anatomis sindrom nefrotik primer pada anak di Indonesia [dissertation]. [Jakarta]: FKUI; 1992.
5. Merritt RJ, Hack SL, Kalsch M, Olson D. Corticosteroid therapy-induced obesity in children. Clin Pediatr. 1986;25:149–52.
6. Foster BJ, Shults J, Zemel BS, Leonard MB. Risk factors for glucocorticoid-induced obesity in children with steroid sensitive nephrotic syndrome. Pediatr Nephrol. 2006;21:973–80.
7. Thompson FE, Byers T. Dietary assessment resource manual. J Nutr. 1994;124:2245S-317S.
8. Kowalski KC, Crocker PRE, Donen RM. The physical activity questionnaire for older children (PAQ-C) and adolescents (PAQ-A) manual. Canada: University of Saskatchewan;2004.
9. Vidianty J, Pardede SO, Hendarto A and Akib AAP. Obesity in children with frequent relapse and steroid dependent nephrotic syndrome. Paediatr Indones. 2010;50:139-43.
10. Olowu WA, Adelusola KA, and Adefehinti O. Childhood idiopathic steroid resistant nephrotic syndrome in
Southwestern Nigeria. Saudi J Kidney Dis Transpl. 2010;21:979-90.
11. Hoyer PF, Brodehl J. Initial treatment of idiopathic nephrotic syndrome in children: prednisone versus prednisone plus cyclosporine A: a prospective, randomized trial. J Am Soc Nephrol. 2006;17:1151–7.
12. Kim JS, Bellew CA, Silverstein DM, Aviles DH, Boineau FG, Vehaskari VM. High incidence of initial and late steroid resistance in childhood nephrotic syndrome. Kidney Int. 2005;68:1275–81.
13. Ashwell M. Charts based on body mass index and waist-to-height ratio to assess the health risks of obesity: a review. Open Obes J. 2011;3:78-84.
14. Panjikkaran ST. Waist to height ratio for recording the risks of overweight in schoolchildren in Kerala. Indian Pediatr. 2013;50:493-5.
15. Lee KK, Park HS and Yum KS. Cut-off values of visceral fat area and waist-to-height ratio: diagnostic criteria for obesity related disorders in Korean children and adolescents. Yonsei Med J. 2012;53:99-105.
16. Niaudet P. Long-term outcome of children with steroid sensitive idiopathic nephrotic syndrome. Clin J Am Soc Nephrol. 2009;4:1547–8.
17. Cavagnini F, Croci M, Putignano P, Petroni ML, Invitti C. Glucocorticoids and neuroendocrine function. Int J Obes Relat Metab Disord. 2000;24:S77-9.
18. Stewart PM. The adrenal cortex. In: Larson PR, Kronenberg H, Melmed S, editors. William’s textbook of endocrinology. 10th edition. Philadelphia: Saunders; 2003. p. 491-551.
19. Liu D, Ahmet A, Ward L, Krishnamoorthy P, Mandelcorn ED, Leigh R, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9:30.