Ocular complications in pediatric nephrotic syndrome treated with corticosteroids

  • Yulia Margareta L. Toruan Faculty of Medicine, Universitas Indonesia
  • Partini Pudjihastuti Trihono
  • Rita Sita Sitorus
  • Pramita Gayatri Dwipoerwantoro
Keywords: children, idiopathic nephrotic syndrome, posterior subcapsular cataract, intraocular pressure


Background Posterior subcapsular cataracts (PSC) and raised intraocular pressure (IOP) are the most common ocular complications of oral steroid administration, particularly following long-term use or treatment with high doses.

Objective To evaluate the association between cumulative steroid dose and duration of treatment with the occurrence of PSC and raised IOP, as well as its associated factors in children with idiopatic nephrotic syndrome (INS).

Methods This cross-sectional study included children aged 4–18 years with INS who received oral steroid therapy for at least six consecutive months. Patients underwent complete eye examinations by an ophthalmologist to evaluate their visual acuity as well as the occurrence of PSC and/or raised IOP. Results Of 92 subjects, 19.6% had PSC, 12% had raised IOP, and one had a best corrected visual acuity (BCVA) of <6/20. The median cumulative steroid dose was 12,161 (range 1,795–81,398) mg and median treatment duration was 23 (range 6–84) months. There were significant positive associations between cumulative steroid dose as well as treatment duration and the occurrence of PSC, with cut-off points of 11,475 mg and 24 months, respectively, as determined by receiver operator characteristic (ROC) curves. Females were four times more likely to have PSC compared to males (PR 4; 95%CI 1.57 to 13.38; P=0.001). Cumulative steroid dose and duration of treatment were not associated with raised IOP.

Conclusion Cumulative steroid dose of 11,475 mg or higher and/or duration of steroid therapy of 24 months of more were significantly associated with the occurrence of PSC, but not with raised IOP.


1. Andolino TP, Reid–Adam J. Nephrotic syndrome. Pediatr Rev. 2015;36:117–25. DOI: https://doi.org/10.1542/pir.36-3-117.
2. Wirya IGNW. Penelitian beberapa aspek klinis dan patologi anatomis sindrom nefrotik primer pada anak di Indonesia [dissertation]. [Jakarta]: Faculty of Medicine, Universitas Indonesia; 1992.
3. The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. A report of the International Study of Kidney Disease in Children. J Pediatr. 1981;98:561-4. DOI: https://doi.org/10.1016/s0022-3476(81)80760-3.
4. Seth A, Aggrawal A. Monitoring adverse reaction to steroid therapy in children. Indian Pediatr. 2004;41:349–57. PMID: 15123863.
5. Gilbert C, Foster A. Childhood blindness in the context of VISION 2020—the right to sight. Bull World Health Organ. 2001;79:227–32. PMID: 11285667. PMCID: PMC2566382.
6. Olanan LRN, Pangilinan CAG, Yatco MM. Steroid-induced cataract and glaucoma in pediatric patients with nephrotic syndrome. Philipp J Ophthal. 2009;34:59–62.
7. Kobayashi Y, Akaishi K, Nishio T, Kobayashi Y, Kimura Y, Nagata M. Posterior subcapsular cataract in nephrotic children receiving steroid therapy. Am J Dis Child. 1974;128:671–3. DOI:10.1001/archpedi.1974.02110300081010
8. Gaur S, Joseph M, Nityanandam S, Subramanian S, Koshy AS, et al. Ocular complications in children with nephrotic syndrome on long term oral steroids. Indian J Pediatr. 2014;81:680-3. DOI: https://doi.org/10.1007/s12098-014-1338-2
9. Hayasaka Y, Hayasaka S, Matsukura H. Ocular findings in Japanese children with nephrotic syndrome receiving prolonged steroid therapy. Ophtalmologica. 2006;220:181-5. DOI: https://doi.org/10.1159/000091762
10. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140:1-40. DOI: https://doi.org/10.1542/peds.2017-1904
11. Nephrology Coordination Working Unit of Indonesian Pediatric Society. In: Trihono PP, Alatas H, Tambunan T, Pardede SO, editors. Konsensus tata laksana sindrom nefrotik idiopatik pada anak. 2nd ed. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia; 2012. p. 2–3.
12. Lai CH, Fan DSP, Chan JCH. Corticosteroid-induced glaucoma in children. HK J Ophthal. 2014;18:14–9.
13. World Health Organization. Geneva: VISION 2020 The right to sight: Global initiative for the elimination of avoidable blindness action plan 2006–2011. Geneva, Switzerland: World Health Organization WHO Press; 2007.
14. Ng JSK, Wong W, Law RWK, Hui J, Wong EN, Lam DSC. Ocular complications of pediatric patients with nephrotic syndrome. Clin Exp Ophthalmol. 2001;29:239–43. DOI: https://doi.org/10.1046/j.1442-9071.2001.00426.x.
15. Habibzadeh F, Habibzadeh P, Yadollahie M. On determining the most appropriate test cut-off value: the case of tests with continuous results. Biochem Med. 2016;26:297–307. DOI: https://doi.org/10.11613/bm.2016.034.
16. James ER. The etiology of steroid cataract. J Ocul Pharmacol Ther. 2007;23:403–20. DOI: https://doi.org/10.1089/jop.2006.0067.
17. Agrawal V, Devpura K, Mishra L, Agrawal S. Study on steroid induced ocular findings in children with nephrotic syndrome. J Clin Diagn Res. 2017;11:SC05-SC06. Doi: 10.7860/JCDR/2017/24694.9334
18. Phulke S, Kaushik S, Kaur S, Pandav SS. Steroid-induced glaucoma: an avoidable irreversible blindness. J Curr Glaucoma Pract. 2017;11:67–72. DOI: https://doi.org/10.5005/jp-journals-l0028-1226
19. Sari MD, Amra AA. The effect of steroid on intraocular pressure in children with nephrotic syndrome. IOSR–JPBS. 2018;13:18–21. DOI: 10.9790/3008-1302041821
20. Kawaguchi E, Ishikura K, Hamada R, Nagaoka Y, Morikawa Y, Sakai T, et al. Early and frequent development of ocular hypertension in children with nephrotic syndrome. Pediatr Nephrol. 2014;29:2165–71. DOI: 10.1007/s00467-014-2848-x.
21. Fournier C, Milot JA, Clermont MJ, O’Regan S. The concept of steroid cataractogenic factor revisited. Can J Ophthalmol. 1990;25:345–7. PMID: 2090339.
22. Nguyen TD, Chen P, Huang WD, Chen H, Johnson D, Polansky JR. Gene structure and properties of TIGR, an olfactomedin-related glycoprotein cloned from glucocorticoid-induced trabecular meshwork cells. J Biol Chem. 1998;273:6341–50. DOI: https://doi.org/10.1074/jbc.273.11.6341.
23. Brown CJ, Akaichi F. Vitamin D deficiency and posterior subcapsular cataract. Clin Ophthalmol. 2015;9:1093–8. DOI: https://doi.org/10.2147%2FOPTH.S84790.
24. Nakamura T, Sasaki H, Nagai K, Fujisawa K, Sasaki K, Suzuki K, et al. Influence of cyclosporin on steroid-induced cataracts after renal transplantation. Jpn J Ophthalmol. 2003;47:254–9. DOI: https://doi.org/10.1016/s0021-5155(03)00020-0.
25. Rajeghinezad MR, Katz LJ. Steroid-induced iatrogenic glaucoma. Ophthalmic Res. 2012;47:66–80. DOI: https://doi.org/10.1159/000328630.
How to Cite
L. Toruan Y, Trihono P, Sitorus R, Dwipoerwantoro P. Ocular complications in pediatric nephrotic syndrome treated with corticosteroids. PI [Internet]. 6Feb.2024 [cited 18Apr.2024];64(1):1-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/3297
Pediatric Nephrology
Received 2023-01-03
Accepted 2024-02-06
Published 2024-02-06