Untitled

Abstract

Minimal change nephrotic syndrome (MCNS) is the major type of idiopathic nephrotic syndrome in children. Glucocorticoids and immunosuppressive agents are used for the treatment of MCNS. Although proteinuria resolves with glucocorticoids therapy in 90% of patients, the disease relapses in about 70% of them with the recurrence of proteinuria. Therefore, some children with MCNS need long−term glucocorticoid therapy. Growth failure is common during long−term treatment with glucocorticoids, although the cause of this complication is unknown. Since long− term glucocorticoid therapy is often required to treat nephrotic syndrome, growth retardation occurs in some patients. The growth of 75 patients with steroid−dependent nephrotic syndrome treated at our institution was evaluated. In6patients with growth retardation, serum levels of growth hormone and insulin−like growth factor were measured. Growth hormone deficiency was detected in 5 of them, and they were diagnosed as having glucocorticoid−induced growth failure. Recombinant growth hormone (GH) was administered to 4 of these 5 patients. Case 1 : A 9−year−old girl, who had developed nephrotic syndrome at the age of 2 years, with a height of 118.0 cm (−2.30 SD) was treated with GH for 6 years, and her height increased to 152.4 cm (−1.10 SD). Case 2 : A 14−year−old boy, who had developed nephrotic syndrome at the age of 3 years, with a height of 144.2 cm (−3.17 SD) was treated with GH for 3 years, and his height improved to 168.6 cm (−0.38 SD). Case 3 : A 15−year−old boy, who had developed nephrotic syndrome at the age of 5 years, with a height of 144.4 cm (−3.67 SD) was treated with GH for 26 months, and his height increased to 170.3 cm (−0.05 SD). Case 4 : An 11−year−old boy, who had developed nephrotic syndrome at the age of 3 years, with a height of 124.3 cm (−2.83 SD) was treated with GH for 66 months, and his height improved to 163.6 cm (−1.16 SD). Thus, all patients showed an increase of growth and reached the target range. The mean duration of glucocorticoid therapy before diagnosis of glucocorticoid−induced growth failure was,107,months and all patients displayed GH deficiency. This implies that GH deficiency is the cause of glucocorticoid−induced growth failure and we suggest that GH therapy is effective for the treatment of growth retardation.