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Background Disturbances in bone mineral metabolism and side effects of corticosteroid treatment may cause decreased bone density in patients v.ith nephrotic syndrome (NS).
Objectives To compare the prevalence oflow bone mineral density (BMD) in children with and 'Without NS and to assess the effect of corticosteroid treatment on bone density in NS patients.
Methods We conducted a retrospective, cohort study in children aged 5-18 years diagnosed 'With NS for more than 2 months prior to data collection, and in children v.ithout NS as a control. BMD was assessed on calcaneal bone wlith ultrasound bone densitometry. Serum calcium, albumin, creatinine and phosphate levels were also assessed.
Results The prevalence of low BMD was significantly higher in NS patients than nonNS subjects, 73.3% (22 in 30) vs. 33% (11 in 33), respectively. The prevalence ratio was 6.3 (95% CI 2.1 to 18.9). NS patients had lower serum calcium levels, With mean difference of -0.17 (95% CI -0.27 to -0.07 mMollL), P<0.009, and lower serum albumin, with mean difference of -0.88 (95% CI -1.27 to -0.49 gIL); P<O.OO 1, than nonNS subjects. After adjusting for other risk factors, we found NS to be an independent risk factor for low BMD. Steroid-resistant and steroid-dependent patients had lower BMD than steroid-sensitive subjects (P=0.02). There was also a significant correlation between the onset of corticosteroid treatment and BMD (r=O.3; P=0.02).
Conclusions NS patients had higher risk for low BMD compared to normal subjects. Response to steroid treatment influences the severity of impaired bone density.
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