Obesity in children with frequent relapse and steroid dependent nephrotic syndrome

Jeanne Vidianty; Sudung O. Pardede; Aryono Hendarto; Arwin A. P. Akib

doi:10.14238/pi50.3.2010.139-43

Jeanne Vidianty Department of Child Health, Medical School, University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta
Sudung O. Pardede Department of Child Health, Medical School, University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta
Aryono Hendarto Department of Child Health, Medical School, University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta
Arwin A. P. Akib Department of Child Health, Medical School, University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta

DOI: https://doi.org/10.14238/pi50.3.2010.139-43

Keywords: frequent relapse nephrotic syndrome, steroid dependent, glucocorticoid, obesity

Abstract

Background Children \\lith frequent relapse and steroid dependentÂ nephrotic syndrome (FRNS/SDNS) will experience frequentÂ relapse v.ith many complications due to the disease and toxicity ofÂ steroid therapy. One of the most common complications is obesityÂ which is associated \\lith significant health problems in childhoodÂ and important risk factor of adult morbidity and mortality.Â

Objective To find out the prevalence of obesity in children 'WithÂ FRNS/SDNS.

Methods A cross sectional study was conducted from NovemberÂ 2008 until March 2009. Data were collected from the medicalÂ records of children 'With FRNS/SDNS treated during the period ofÂ 2000-2008. Body weight, height and body fat mass measurementÂ was performed on the subjects. The diagnosis of obesity was basedÂ on body mass index (BMI) and body fat mass measurement.

Results Obesity was diagnosed in 10 of 43 children (23%). MostÂ of them were 5ô€€¼9 years old (58%) 'With maleô€€¼predominance.Â Most patients (70%) had age of onset younger than 5 years. TheÂ median of total relapse was 7 (range 2ô€€¼24) and cumulative doseÂ of prednisone was 12,240 (range 3,490 to 44,330) mg. Time sinceÂ the last dose of prednisone until the study in majority was 0 to 6Â months (53%). The prevalence of obesity based on BMI was 7%
while based on body fat mass was 23 (el 95% 10 to 36) %.Â

Conclusion The prevalence of obesity based on body fat massÂ was 23%. The median BMI of obese subjects is in the 90-95thÂ percentile.Â

References

1. Alatas H, Tambunan T, Trihono Pp, Pardede so. Konsensus tata laksana sindrom nefrotik idiopatik pada anak. Jakarta: Unit Kerja Koordinasi Nefrologi Ikatan Dokter Anak Indonesia, 2005; p. 1-18.
2. Tarshish P, Tobin JN, Bernstein J, Edelmann CM. Prognostic significance of the early course of minimal change nephrotic syndrome: Report of the International Study of Kidney Disease in Children. J Am Soc Nephrol. 1997;8;769-76.
3. Haycock G. The child Mth idiopathic nephrotic syndrome. In: Webb N, Postlethwaite R, editors. Clinical paediatric nephrology.3rd ed. New York: Oxford University Press, 2003; p.341-66.
4. Wila Wirya IGN. Penelitian beberapa aspek klinis dan patologi anatomis sindrom nefrotik primer pada anak di Jakarta [Dissertation]. Jakarta: University of Indonesia; 1992.
5. Brewer ED, Berry PL. Glomerulonephritis and nephrotic syndrome. In: McMilan JA, DeAngelis CD, Feigin RD, Warshaw JB, editors. Oski's pediatrics. yd ed. Philadelphia: Lippincott Williams & Wilkins, 1999; p. 1590-4.
6. Emma F, Sesto A, Rizzoni O. Long-term linear growth of children with severe steroid-responsive nephrotic syndrome. Pediatr Nephrol. 2003;18.783-8.
7. Nash lvtA, Edelmann CM, BernsteinJ, Barnett HL. The nephrotic syndrome. In: Edelmann CM, BernsteinJ, Meadow R, Spitzer A, Travis LB, editors. Pediatric kidney disease. 2nd ed. Boston: Little Library of Congress Cataloging-in-Publication Data, 1992; p. 1254.
8. Nash MA, Edelmann CM, BernsteinJ, BarnettHL. Minimal change nephrotic syndrome, diffuse mesangial hypercellularity, and focal glomerular sclerosis. In: Edelmann CM, BernsteinJ, Meadow R, Spitzer A, Travis LB, editors. Pediatric kidney disease. 2nd ed. Boston: little Library of Congress Cataloging-in-Publication Data, 1992; p. 1280.
9. Foster Bj, Shults j, Zemel BS, Leon8Td MB. Risk factors for glucocorticoid-induced obesity in children with steroid-sensitive nephrotic syndrome. Pediatr Nephrol. 2006;21:973-80.
10. Leonard MB, Feldman HI, Shults j, Zemel BS, Foster Bj, Stallings YA. Long-term, high-dose glucocorticoids and bone mineral content in childhood glucocorticoid-sensitive nephrotic syndrome. N Engl j Med. 2004;351.868-75.
11. Freedman DS, Dietz WH, Srinivasan SR, Berenson OS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999; 103.1175-82.
12. Krebs NF, Jacobson MS, Baker RD, Greer FR, Heyman MB, Jaksic T, et al. Prevention of pediatric overweight and obesity. Pediatrics. 2003;1120424-30.
13. Must A, Jacques PF, Dallal OE, Bajema CJ, Dietz WHo Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935. N Engl j Med. 1992;327.1350-5.
14. Baker JL, Olsen LW, Sorensen T I. Childhood body-mass index and the risk of coronary heart disease in adulthood. N Engl j Med. 2007;357.2329-37.
15. Foster BJ, Shults J, Zemel BS, Leonard MB. Interaction between growth and body composition in children treated with high-dose chronic glucocorticoids. Am J Clin Nutr. 2004;80.1334-41.
16. Donatti TL, Koch VH, Fujimura MD, Okay Y. Growth in steroid-responsive nephrotic syndrome: a study of 85 pediatric patients. Pediatr Nephrol. 2003;18.789-95.
17. Ruth EM, Kemper MJ, Leumann EP, Laube OF, Neuhaus TJ. Children mth steroidô€«sensitive nephrotic syndrome come of age: long-term outcome. J Pediatr. 2005; 147 :202-7.
18. Meilany TA. Profit klinis dan laboratoris obesitas pada murid
sekolah dasar [T hesis]. Jakarta: University of Indonesia; 2001.
19. Susanti T E. Prevalens dan faktor risiko obesitas pada anak sekolah dasar usia 1 Oô€« 12 tahun di lima mlayah D KI Jakarta
[Thesis]. Jakarta: University of Indonesia; 2007.
20. Tyrrell Vj, Richards GE, Hofman P, Gillies GF, Robinson E, Cutfield WS. Obesity in Auckland school children: a comparison of the body mass index and percentage body fat as the diagnostic criterion. Int J Obes. 200 1;25: 164-9.
21. Krebs NF, Himes jH, jacobson D, Nicklas TA, Guilday P, Styne D. Assessment of child and adolescent overweight and obesity. Pediatrics. 2007;120.193-230.
22. Olsen LO, Hangen JP. Obesity. In: Hendricks KM, Duggan C, Walker WA, editors. Manual of pediatric nutrition. 3rd ed. Hamilton. BC DeckeJ; 2000; p. 479-81.
23. Neovius MO, Linne Y M , Barkeling BS, Rossner SO. Sensitivity and specificity of classification systems for fatness in adolescents. Am J Clin Nutr. 2004;80:597-603.
24. Bessler S. Nutritional assessment. In: Samour PQ, Helm KK, Lang CE, editors. Handbook of pediatric nutrition. 2nd ed. Maryland: Aspen Publication, 1999; p. 17-21.
25. Taylor RW, jones IE, Williams SM, Goulding A. Body fat percentages measured by dualô€«energy X-ray absorptiometry corresponding to recently recommended body mass index cutoffs for overweight and obesity in children and adolescents aged 3-18 y. Am j Clin Nutr. 2002;76.1416-21.
26. Rashid R . Neill E, Maxwell H, Ahmed SF. Growth and body composition in children with chronic kidney disease. Br J Nutr. 2007;97.232-8.