Jurnal Ayu Bahasa Inggris

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194Paediatr Indones, Vol. 55, No.

Paediatrica IndonesianaVOLUME55

July NUMBER 4

Original Article

Corticosteroids and obesity insteroid-sensitive and

steroid-resistant

nephrotic syndrome

Abstract

Nina Lestari, Neti Nurani, Madarina Julia

N

ephrotic syndrome (NS is !

chronic

Background "hildren #ith nephrotic syndrome

need hi$h%dose corticosteroids to !chie&eremission' Studies h!&e estim!ted ! 5%4)ris* o+ o,esity in these p!tients !+tercorticosteroid tre!tment'

Objective -o determine the pre&!lence o+o,esity in children #ho recei&ed corticosteroids+or nephrotic syndrome. !nd to comp!re the ris*o+ o,esity in children #ith steroid%sensiti&enephrotic syndrome (SSNS !nd steroid%resist!nt nephrotic syndrome (SRNS'

Methods /e per+ormed ! retrospecti&ecohort study in 50 children #ith SSNS or SRNS#ho recei&ed corticosteroid tre!tment' O,esity#!s de1ned to ,e ! BM2%+or%!$e 3%score!,o&e4'0

S6. !ccordin$ to the WHO Growthe!eren"e 200#' "entr!lo,esity #!s de1ned to ,e ! #!ist%to%hei$htr!tio7 0'50'

Results -he o&er!ll pre&!lence o+ o,esity #!s). #ith 8) !nd 94) in the SSNS !nd SRNS$roups. respecti&ely' -he o&er!ll pre&!lence o+centr!l o,esity #!s 50). #ith 54) !nd 4:) in theSSNS !nd SRNS $roups. respecti&ely' -hecumul!ti&e steroid doses in this study #ere notsi$ni1c!ntly di;erent ,et#een the SSNS !nd SRNS$roups' -here #ere !lso no si$ni1c!nt di;erences,et#een $roups +or ris* o+ o,esity (RR '5< 85)"20'5= to 90'88 or centr!l o,esity (RR 9'8< 85)"20'45 to 4'5'

Conclusion 2n children #ith nephrotic syndrome

#ho recei&ed corticosteroids. the pre&!lence o+

o,esity is ) !nd o+ centr!l o,esity is 50)' 2n !comp!rison o+ SSNS !nd SRNS $roups.cumul!ti&e steroid dose !s #ell !s ris*s o+ o,esity!nd centr!l o,esity do not si$ni1c!ntly di;er,et#een $roups' Paediatr Indones!"#$%&%%'$()-*+'

Keywords$ ne%hroti" syndro&e,o'esity, "entral o'esity, 'ody &assinde(, waist)to)hei*ht ratio


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195Paediatr Indones, Vol. 55, No.

$lomerul!r dise!se th!tmostly occursin children' -he incidence o+nephrotic syndrome is %> per900.000 children

per ye!r' 2ndonesi! #!s reported to h!&e: c!ses per900.000 children per ye!r' "hildren #ithnephrotic syndrome recei&e !corticosteroid re$imen to !chie&e !ndm!int!in remission' O+ the potenti!l sidee;ects o+ corticosteroid. o,esity is one o+the most common' ?re&ious studiesestim!ted ! 5%4) ris* o+ o,esity !+ter

tre!tment #ith corticosteroids'9%5

@ si$ni1c!ntly incre!sed ris* o+o,esity in children #ith steroid sensiti&enephrotic syndrome (SSNS h!s ,eenreported'5%: Ao#e&er. pre&ious studiesdid not consider the e;ect o+ the re$imeno+ steroids. cumul!ti&e corticosteroiddose. cumul!ti&e steroid%+ree period.

physic!l !cti&ity or c!lorie int!*e'5

2n !ddition. there h!&e ,een +e#studies on the !ssoci!tion ,et#eennephrotic syndrome (NS !nd the

incidence o+ centr!l o,esity in children':

rom the 6ep!rtment o+ "hild Ae!lth. C!dD!h M!d!Uni&ersity Medic!lSchoolS!rdDito Aospit!l Fo$y!*!rt!.2ndonesi!'

eprint re-uests toG M!d!rin! Juli!. 6ep!rtmento+ "hild Ae!lth. Uni&ersit!s C!dD!h M!d! Medic!lSchool6r' S!rdDito Aospit!l. Jln' Heseh!t!n no'9. Se*ipUt!r!. Fo$y!*!rt! 55=4. 2ndonesi!' -el' 4:%=95%>=505>40. !I' :%>4%5=>45' E%m!ilGm!d!rin!Duli!y!hoo'com.m!d!rin!Duli!u$m'!c'id'
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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Nina +estari et al$ "orticosteroids !nd o,esity

Steroid sensiti&e nephroticsyndrome (SSNS p!tients recei&e+reKuent steroid tre!tment ,ec!use o+

recurrent rel!pses. #hile steroid resist!ntnephrotic syndrome (SRNS p!tientsrecei&e +e#er repe!ted doses. due tothe use o+ steroid%sp!rin$ !$ents' /e!imed to e&!lu!te the ris*s +or o,esity!nd centr!l o,esity in SSNS !nd SRNSchildren'

Methods

/e conducted ! retrospecti&e studyin&ol&in$ ! cohort o+ children #ith NS#ho &isited the Outp!tient "linic o+ the?edi!tric Nephrolo$y 6ep!rtment o+ 6r'S!rdDito Aospit!l +rom Septem,er 9. 09to Octo,er9. 09' -he cohort comprised o+ 50children #ithNS #ho #ere ,orn ,et#een 9885!nd 090'

/e re&ie#ed medic!l records todetermine the type o+ NS. ,!sed on the

corticosteroid re$imen. i'e'. SSNS orSRNS' -he +ollo#in$ in+orm!tion #!s!lso o,t!inedG !$e !t di!$nosis o+ NS.response to steroid tre!tment. type o+corticosteroid used. num,er o+ +ull initi!ldose. cumul!ti&e corticosteroid dose.cumul!ti&e steroid%+ree period. !nd thetime l!psed ,et#een the l!st steroid use!nd the d!y o+ me!surement' /e didnot !ssess su,Dects o,esity st!tus,e+ore the st!rt o+ steroid tre!tment.,ec!use !ll o+ them h!d !n!s!rc!'

2nclusion criteri! #ere children #ithNS. !$ed

%9= ye!rs. in remission #ith ne$!ti&e

or minim!l proteinuri!. #ho #ere either

under$oin$ lo#%dose SUHGQLVRQH WKHUDS\ M

PJ NJ GD\ RU KDG VWRSSHG usin$ steroids'

EIclusion criteri! #ere p!tients #ithedem! or other chronic dise!ses th!t

!;ected $ro#th or ,ody composition'Outcome d!t!. i'e'. !nthropometric

me!sure% ments. #ere o,t!ined #henthe su,Dects &isited the clinic' /ei$hts

#ere me!sured #ith !n electronicdi$it!l sc!le to the ne!rest 0'9 *$. #hilehei$ht #ere me!sured #ith ! st!diometer

to the ne!rest 0'9 cm' 6!t! on #ei$ht!nd hei$ht #ere con&erted into ,odym!ss indeI (BM2 ,y di&idin$ #ei$ht in

*$ ,y hei$ht in meters%sKu!red (*$m'O,esity #!s de1ned !s ! BM2%+or%!$e 3%score !,o&e 4'0 S6. !ccordin$ to theWHO Growth e!eren"e 200#' /!istcircum+erences #ere me!sured #ith !non%stretch!,le me!surin$ t!pe p!ssin$the um,ilicus. to the ne!rest 0'9 cm'"entr!l o,esity #!s de1ned !s ! #!ist%to%hei$ht r!tio7 0'50'


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Nina +estari et al$ "orticosteroids !nd o,esity

6!t! t!*en +rom medic!l records#ere !$e !t NS di!$nosis. response tosteroid tre!tment. type o+ corticosteroidused. num,er o+ +ull initi!l dose.cumul!ti&e corticosteroid dose.cumul!ti&e steroid% +ree period. !nd thetime l!psed ,et#een the l!st steroid use!nd the d!y o+ me!surement'

6iet #!s !ssessed usin$ ! 4%hour diet!ry rec!ll method' Su,Dects.p!rents. or c!re$i&ers #ere inter&ie#edto rec!ll +oods th!t #ere consumed ,y thesu,Dects in the 4 hours prior to theinter&ie#' -his in+orm!tion #!s completed,y the +ollo#in$G ho# the +ood #!s coo*ed!nd ser&ed. +ood ,r!nd. num,er. !nd

portion sie o+ the +ood'>

?hysic!l !cti&ity #!s me!sured usin$the Physi"al

"ti-ity .uestionnaire !or Older /hildren(?@%"!ndPhysi"al "ti-ity .uestionnaire !or

doles"ents (?@%@'=

-hese Kuestionn!ires #ere used to !ssessthe su,DectsLphysic!l !cti&ity durin$ the se&end!ys prior'

6!t! #ere !n!lyed usin$ "hi%

sKu!re !nd ishers test #ith ! 85)con1dence le&el ("2. D o+ 5). !nd po#ero+ =0) #ith 0) E. !t ! si$ni1c!nce le&elo+ ? P 0'05' -he ris* +or o,esity !ndcentr!l o,esity #!s c!lcul!ted usin$rel!ti&e ris* (RR #ith 85)"2' ?e!rsonscorrel!tion #!s used to !ssess +or!ssoci!tions ,et#een cumul!ti&ecorticosteroid dose. cumul!ti&e steroid%+ree period. !nd time l!psed ,et#eenl!st steroid use !nd the d!y o+me!surement. !nd BM2 3%scores !nd

#!ist%to%hei$ht r!tios' -his study #!s!ppro&ed ,y the Ethics "ommittee +orRese!rch !t C!dD!h M!d! Uni&ersity'

,esults

i+ty children #ere included !s su,Dects o+the study' -he su,Dects ch!r!cteristics!re presented in .able$' -he o&er!ll pre&!lence o+ o,esity #!s

). == in SSNS $roup !nd (E( in SRSS$roup' -he o&er!ll pre&!lence o+ centr!lo,esity #!s 50). 95= in SSNS $roup!nd 90E in SRNS $roup' -here #ere nosi$ni1c!nt di;erences ,et#een the SSNS!nd the SRNS $roups in terms o+ ris*s o+o,esity (RR '5.00m$ tendin$ to h!&e more

centr!l o,esity< ,ut this result #!s notst!tistic!lly si$ni1c!nt (RR 9'>:< 85)"20'88 to '9'

-here #ere no si$ni1c!nt correl!tions,et#een cumul!ti&e corticosteroid dose.cumul!ti&e steroid% +ree period. or thetime l!psed ,et#een l!st steroid use!nd the d!y o+ me!surement. !nd BM23%scores or #!ist%to%hei$ht r!tio (.able/'

Table 1. Baseline characteristics of subjects

Characteristics SNSS group

(n= 28)

Gender, n

SNS group

(n = 22)

! "alue

#$#%

&ale

'eale2 *%

+

&ean age at diagnosis (S), -ears .$#. ($**) .$2+ ($/%) #$+/b

0-pe of corticosteroid, n

!rednisone

&eth-lprednisolone

'ull initial dose, c n

* tie

1* ties

2 */

% /

8 *

2# .

#$*/a

#$#*

&ean cuulati"e corticosteroid dose (S), g34g B5 2*+$8 (*2.$%*) 2+8$+* (2*+$++) #$*2b

&ean steroid6free duration (S), onths *8$/ (%#$++) *2$#+ (2*$/) #$#2b

&ean tie lapsed bet7een last dose of steroid

until the stud- "isit (S), onths

!h-sical acti"it-,d n

o7 (score *6%)

9igh (score 6)

%$22 (+$*.) *$# (2$2#) #$#*b

*$##a

2. 22

* #

&ean dail- energ- inta4e (S),e : ; .#$*8 (22$%+) .$* (2%$28) #$*

&ean 7aist circuference (S), c //$+8 (*#$.*) /$%/ (*2$8.) #$2+b

&ean hip circuference (S), c .2$2* (*2$%) .*$* (*2$/) #$82

&ean ar circuference (S), c 2*$2 (%$+%) 2#$.. ($#.) #$b

&ean 7aist6to6height ratio (S) #$2 (#$#8) #$* (#$#8) #$82b

&ean B&< 6score (S) #$.# (*$8) #$ (*$2) #$%

SSNS> steroid6sensiti"e nephrotic s-ndroe, SNS> steroid6resistant nephrotic s-ndroe, B& bod- ass inde?$a 'isher@s A?act 0est

b &ann65hitne- 0est

c standard full corticosteroid treatent for initial episode of NS

d easured 7ith ph-sical acti"it- uestionnaire for older children and adolescents

e easured 7ith a 26hour6recall diet

Table 2$ ;ssociation bet7een SSNS or SNS and obesit- or central obesit-

0-pe of obesit- SSNS group

(n=28)

SNS group

(n=22)

(+:C


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a B&


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Table 3$ !earson@s correlation bet7een cuulati"e corticosteroid dose, cuulati"e steroid6free period, and the tielapsed bet7een last steroid use and the da- of easureent and B&< 6scores and 7aist6to6height ratio

B&


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receptor in oment!l !dipose tissue.resultin$ in centr!l !nd &iscer!l

o,esity':.9:%9=

@ pre&ious study sho#ed !n

!ssoci!tion ,et#een hi$her cumul!ti&edose !nd ris* o+ o,esity' Liu et al'o,ser&ed ! 4 to =) #ei$ht $!in #ith 5to 90 m$d!y prednisone +or more th!n ye!rs. #ith !n !&er!$e cumul!ti&edose o+ >.00 m$'98 @lthou$h notst!tistic!lly si$ni1c!nt. #e o,ser&ed !hi$her ris* o+ centr!l o,esity in those #horecei&ed more th!n >.00 m$ o+prednisone'

2n conclusion. #e 1nd no si$ni1c!nt!ssoci!tion ,et#een steroid re$imen

!nd the ris* o+ o,esity or centr!lo,esity in children #ith nephroticsyndrome'

Con1ict o2interest

None decl!red'

,e2erences

9' Behrm!n RE. Hlie$m!n RM. Jenson AB' Nephroticsyndrome'

2nG Nelson teIt,oo* o+ pedi!trics' 9>th ed'

?hil!delphi!G S!unders< 004' p' 9>5%='

' Cipson 6S. M!ssen$ill S. F!o L. N!$!r!D S.

Smoyer /E. M!h!n J6. et al' M!n!$ement o+

childhood onset nephrotic syndrome'

?edi!trics' 0084>%5>'

' Eddy @@. Symons JM' Nephrotic syndrome inchildhood'

L!ncet' 00


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sensiti&e nephrotic syndrome' ?edi!trNephrol' 00:T=0'

>' -hompson E. Byers -' 6iet!ry !ssessmentresource m!nu!l'

J Nutr' 9884S'

=' Ho#!ls*i H". "roc*er ?RE. 6onen RM' -he

physic!l !cti&ity Kuestionn!ire +or older

children (?@%" !nd !dolescents (?@%@

m!nu!l' "!n!d!G Uni&ersity o+

S!s*!tche#!n

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