ESPE Abstracts

Background: Adrenal insufficiency is a potential complication of prolonged exogenous steroid therapy in patients with nephrotic syndrome. Despite its clinical significance, there is limited information on its prevalence and associated risk factors in pediatric populations. This study aims to estimate the prevalence of adrenal insufficiency in children with nephrotic syndrome and identify the associated risk factors.

Methods: This prospective observational study was conducted in the Department of Pediatrics at King George's Medical University, Lucknow. The study population included children aged 2-12 years diagnosed with steroid-sensitive nephrotic syndrome. Comprehensive histories and physical examinations were performed to identify potential risk factors. Early morning serum cortisol levels and low-dose ACTH stimulation tests (LDSTs, 0.5 μg/m²) were conducted 4-6 weeks post-corticosteroid therapy discontinuation. Adrenal insufficiency was defined by early morning serum cortisol levels <83 nmol/L (3 μg/dL) and LDST results <500 nmol/L (18 μg/dL).

Results: Of the 75 children enrolled, 27 (36%) demonstrated HPA axis suppression. Among these patients, 74.1% were male. Age distribution at the time of the LDST was 62.9% (2-5 years), 22.2% (6-9 years), and 14.8% (10-12 years). The onset of the first nephrotic syndrome episode occurred at 70.37% (2-5 years), 8.52% (6-9 years), and 14.81% (10-12 years). Among the HPA-suppressed group, 22.2% were experiencing their first nephrotic syndrome episode, and 22.2% were steroid-dependent. The median duration of steroid treatment was 24 weeks (12-42), with a mean daily dose of 1.94 mg/kg. Blood pressure measurements revealed that 62.9% had normal BP, 3.70% were pre-hypertensive, 22.2% had stage 1 hypertension, and 11.1% had stage 2 hypertension. The median BMI was 17.20 (16.00-18.90) in the suppressed HPA group compared to 16.90 (15.65-18.85) in the non-suppressed group. However, none of our study's risk factors were significant in predicting adrenal insufficiency.

Conclusion: Adrenal insufficiency is prevalent in children with nephrotic syndrome undergoing long-term glucocorticoid therapy. These findings underscore the importance of routine adrenal function screening in this population to prevent potential relapses and manage associated health risks effectively. Early detection and intervention are critical to improving outcomes in pediatric nephrotic syndrome patients.