Growth in children with nephrotic syndrome: a post hoc analysis of the NEPTUNE study

期刊论文
发表日期：

2024年4月26日

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Aesha Maniar,
Debbie S. Gipson,
Tammy Brady,
Tarak Srivastava,
David T. Selewski,
Larry A. Greenbaum,
Katherine M. Dell,
Frederick Kaskel,
Susan Massengill,
Cheryl Tran,
Howard Trachtman,
Richard Lafayette,
Salem Almaani,
Sangeeta Hingorani,
Chia-shi Wang,
Kimberly Reidy,
Gabriel Cara-Fuentes,
Rasheed Gbadegesin,
Kevin Myers,
Christine B. Sethna,
M. Schachere,
J. Negrey,
J. Scott,
S. Morrison,
M. Pfaiff,
P. Canetta,
A. Pradhan,
E. Yun,
S. Adler,
J. LaPage,
A. Athavale,
M. Itteera,
M. Atkinson,
T. Dell,
F. Fervenza,
M. Hogan,
J. Lieske,
G. Hill,
M. Ross,
P. Flynn,
J. Kopp,
L. Malaga-Dieguez,
O. Zhdanova,
F. Modersitzki,
L. Pehrson,
B. Yeung,
I. Lee,
S. Quinn-Boyle,
H. Reich,
M. Hladunewich,
P. Ling,
M. Romano,
A. Fornoni,
C. Bidot,
C. Klida,
V. Derebail,
K. Gibson,
A. Froment,
F. Ochoa-Toro,
K. Meyers,
K. Kallem,
A. Swenson,
K. Sambandam,
K. Aleman,
M. Rogers,
A. Jefferson,
K. Tuttle,
L. Manahan,
E. Pao,
A. Copper,
JJ Lin,
Stefanie Baker,
M. Kretzler,
L. Barisoni,
C. Gadegbeku,
B. Gillespie,
L. Holzman,
L. Mariani,
M. Sampson,
J. Sedor,
J. Zee,
G. Alter,
H. Desmond,
S. Eddy,
D. Fermin,
M. Larkina,
S. Li,
S. Li,
C. C. Lienczewski,
T. Mainieri,
R. Scherr,
A. Smith,
A. Szymanski,
A. Williams,
Carmen Avila-Casado,
Serena Bagnasco,
Joseph Gaut,
Stephen Hewitt,
Jeff Hodgin,
Kevin Lemley,
Matthew Palmer,
Avi Rosenberg,
Virginie Royal,
David Thomas,
Cynthia Nast

摘要

Background

Steroids, the mainstay of treatment for nephrotic syndrome in children, have multiple adverse effects including growth suppression.

Methods

Anthropometric measurements in children < 18 years enrolled in the Nephrotic Syndrome Study Network (NEPTUNE) were collected. The longitudinal association of medication exposure and nephrotic syndrome characteristics with height z-score and growth velocity was determined using adjusted Generalized Estimating Equation regression and linear regression.

Results

A total of 318 children (57.2% males) with a baseline age of 7.64 ± 5.04 years were analyzed. The cumulative steroid dose was 216.4 (IQR 61.5, 652.7) mg/kg (N = 233). Overall, height z-scores were not significantly different at the last follow-up compared to baseline (− 0.13 ± 1.21 vs. − 0.23 ± 1.71, p = 0.21). In models adjusted for age, sex, and eGFR, greater cumulative steroid exposure (β − 7.5 × 10⁻⁶, CI − 1.2 × 10⁻⁵, − 3 × 10⁻⁶, p = 0.001) and incident cases of NS (vs. prevalent) (β − 1.1, CI − 2.22, − 0.11, p = 0.03) were significantly associated with lower height z-scores over time. Rituximab exposure was associated with higher height z-scores (β 0.16, CI 0.04, 0.29, p = 0.01) over time.

Conclusion

Steroid dose was associated with lower height z-score, while rituximab use was associated with higher height z-score.

Graphical abstract