Skeletal effects of short-term prednisolone therapy in children with steroid-responsive nephrotic syndrome

Abstract

Background. Osteoporosis or bone fracture can be induced in nephrotic children treated long-term with high doses of glucocorticoids. The purpose of this study was to determine whether short-term prednisolone therapy affects the skeleton in children with steroid-responsive nephrotic syndrome (NS). Methods. Bone mineral density (BMD) and biochemical parameters of mineral and skeletal homeostasis in nine children (four girls, five boys) aged between 2 and 7 years at the first episode of NS were measured. Prednisolone was started at 60 mg/m 2 for 4 weeks, then decreased every 2 weeks for 12 weeks. All patients were steroid-responsive and had no relapse. All patients were examined at 0, 4, and 12 weeks of prednisolone therapy, and 16 weeks after the cessation of prednisolone therapy. Results. The Z-scores (BMD) before prednisolone therapy (Ϫ0.79 Ϯ 0.51) were slightly low. The Z-scores at 4 weeks (Ϫ1.37 Ϯ 0.46) and at 12 weeks of therapy (Ϫ1.22 Ϯ 0.36) were significantly lower than those at 16 weeks after the cessation of prednisolone therapy (Ϫ0.29 Ϯ 0.29). There was also a significant decrease in the mean serum levels of alkaline phosphatase, osteocalcin, and urinary deoxypyridinoline during the short-term prednisolone therapy. However, BMD and biochemical parameters of mineral and skeletal homeostasis returned to normal values at 16 weeks after the cessation of prednisolone therapy. Conclusions. Skeletal effects of short-term prednisolone therapy for 16 weeks were transient in children with steroidresponsive NS without relapse.

Analysis of High Dose and Long-Term Prednisone Therapy on Osteocalcin Levels in Children With Nephrotic Syndrome (Study at Pediatric Department Nephrology Division of Dr. Soetomo Teaching Hospital Surabaya)

“…Kano et al [18] observed osteocalcin levels 8 weeks after the alternate phase and showed increasing from 6.7±2.6 µg/l to 15.0±6.4 µg/l. As mentioned previously that study of osteocalcin levels after 4 weeks the alternate phase in NS patients have not been evaluated.…”

“…Osteocalcin levels of initial attack, infrequent relapses, frequently relapsing, and dependent steroid NS at t=0, t=1, t=2 were not significantly different because patients were given the same dose. Kano et al [18] reported osteocalcin levels of children with steroidresponsive NS 4 weeks after starting prednisolone therapy (induction phase) decreased 68.54%. The other study that was reported by Mohamed and Abdul-Latif [19], osteocalcin levels decreased 30.59% after 1 month of therapy in the initial attack NS.…”

Comparisons of bone mineral density in steroid dependent, frequent relapse, and infrequent relapse nephrotic syndrome children

“…Although FRNS subgroup had higher number of relapses, longer steroid therapy, and greater cumulative steroid, this occurrence might be caused by the longer relapse free interval of FRNS subgroup. As Kano et al 19 stated, the decrease of lumbal bmD after 16 weeks short-term prednisolone therapy were transient and would normalize by 16 weeks after the cessation of therapy. So, this might explain the results, since the relaps free interval median of FRNS group were 28 weeks while median of IRNS group were only 8 weeks.…”