ESPE2022 Poster Category 2 Fat, Metabolism and Obesity (36 abstracts)
The effects of Long-term (five years) Prednisone Therapy in Frequently Relapsing Nephrotic Syndrome of Childhood: Impact on glycemia and the different components of the metabolic syndrome (MetS)
Noor Hamed , Ashraf Soliman , Nada Alaaraj , Shayma Ahmed , Fawzia Alyafei , Maya Itani , Fatima Al-Naimi , Doaa Al-Yousef , Mona Shaat & Mostafa El Baba
Hamad General Hospital, Doha, Qatar
Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have various common metabolic side effects including hypertension, dysglycemia, and diabetes. Proposed risk factors for steroid-induced dysglycemia and metabolic syndrome include cumulative dose, longer duration of steroid course, and high body mass index.
Aim: This study was carried out to investigate the prevalence of different metabolic components and dysglycemia in children with nephrotic syndrome (SSNS) with multiple relapses for 5 years in relation to the cumulative dose of steroids.
Methods: Data of 30 children with childhood Nephrotic Syndrome (NS) was analyzed retrospectively. They received prednisolone treatment according to The International Pediatric Nephrology Association (IPNA) guidelines for initial treatment and relapse. The cumulative dose of steroids over the period of 5 years was calculated for each child. The growth data were recorded along the treatment period. The different metabolic criteria including impaired fasting glucose (IFG), high LDL and cholesterol, lower HD, and high blood pressure for age and sex were studied over this period.
Results: The mean cumulative prednisone = 100+/- 63 mg /kg/yr given over an average duration of 5 years. Obesity (OB) and overweight (OW) increased from 25% pre-treatment to 59.2% after 5 years of treatment. After 3 and 5 years of treatment IFG was found in 24 and 36 % respectively, high LDL in 89% and 80% respectively, high cholesterol in 85% and 100% respectively. Hypertension (BP > 95th percentile) was detected in 14% and 40% of patients after 3 and 5 years of treatment. The mean serum cholesterol and LDL levels were significantly higher than normal in treated children after 3 and 5 years of treatment.
| Variables | Beginning | 3 yr | 5 yr | P-value |
| Number | 30 | 30 | 30 | |
| IFG (FBG >5.6 mmol/l | 15.93% | 24.14% | 35.71% | 0.1 |
| LDL > 2.7 mmol/L | 88.89% | 88.89% | 80.00% | 0.35 |
| HDL < 1.03 mmol/L | 10.53% | 10.00% | 0.00% | 0.07 |
| TG >1.7 mmol/l | 77.27% | 33.33% | 60.00% | 0.23 |
| Cholesterol > 4.5 mmol/L | 100.00% | 85.71% | 100.00% | 1 |
| BP >95th centile for age | 33% | 14.3% | 40% | 0.9 |
Conclusion: Long-term prednisone therapy (for 5 years) with a mean cumulative dose of prednisone = 100+/- 63 mg/kg/yr. was associated with increased prevalence of OW and obesity as well as with a higher risk of developing hypertension and dyslipidemia.
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