Skip to main content
Log in

Influence of steroid medication on bone mineral density in children with nephrotic syndrome

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Bone mineral density (BMD) was studied in 26 children with idiopathic nephrotic syndrome and in age-and sex-matched healthy controls. BMD was selectively measured in trabecular (TBD), cortical (CBD) and total bone (BD) using peripheral quantitative computed tomography. Patients showed a decrease in BD, CBD and TBD, BD and CBD were inversely correlated with the cumulative dose of steroid treatment. Of the 26 patients with high cumulative doses of steroid, 16 were also treated with cyclophosphamide. In this group BD and CBD were decreased significantly compared with the children with a low cumulative steroid dose only. Compared with controls for each subgroup, significant decreases in BD, CBD and TBD were found in the group with high cumulative doses of steroids only. The higher cumulative steroid dose and the initial steroid toxicity which made cytotoxic therapy necessary, rather than cyclophosphamide itself, may be responsible for these findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. International Study of Kidney Disease in Children (1978) Nephrotic syndrome in children: prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. Kidney Int 13: 159–165

    Google Scholar 

  2. International Study of Kidney Disease in Children (1981) The primary nephrotic syndrome in children. Identification of patients with minimal-change nephrotic syndrome from initial response to prednisone. J Pediatr 98: 561–564

    Google Scholar 

  3. Arbeitsgemeinschaft für Pädiatrische Nephrologie (1988) Short versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Lancet 1: 380–383

    Google Scholar 

  4. Lam CN, Arneil GC (1968) Long-term dwarfing effects of corticosteroid treatment of childhood nephrosis. Arch Dis Child 43: 589–594

    Google Scholar 

  5. Rees L, Greene SA, Adlard P, Joners J, Haycock GB, Rigden SPA, Preece M, Chantler C (1988) Growth and endocrine function in steroid sensitive nephrotic syndrome. Arch Dis Child 63: 484–490

    Google Scholar 

  6. Arbeitsgemeinschaft für Pädiatrische Nephrologie (1987) Cyclophosphamide treatment of steroid dependent nephrotic syndrome: comparison of eight week with twelve week course. Arch Dis Child 62: 1102–1106

    Google Scholar 

  7. Barratt TM, Cameron JS, Chantler C, Ogg CS, Soothill JF (1973) Comparative trial of 2 weeks and 8 weeks cyclophosphamide in steroid-sensitive relapsing nephrotic syndrome of childhood. Arch Dis Child 48: 286–290

    Google Scholar 

  8. Dambacher MA, Rüegsegger P (1985) Nichtinvasive Untersuchungsmethoden bei Osteoporosen. Ther Umsch 42: 339–350

    Google Scholar 

  9. Schneider P, Berger P, Moll E, Reiners Chr, Börner W (1986) Knochendichtemessung von Spongiosa und Kompakta mit einem J-125 CT-Scanner: Bestimmung des Mineralgehalts im Radius mit zwei unterschiedlichen Methoden. In: Höfer R, Bergmann H (eds) Radioaktive Isotope in Klinik und Forschung. Egermann, Wien, Band 17: 731–739

    Google Scholar 

  10. Laßmann M, Börner W (1993) Die Strahlenexposition bei Knochendichtemessungen. In: Holeczke F, Reiners Chr, Messer-schmidt O (eds) Strahlenexposition bei neuen diagnostischen Verfahren. Gustav Fischer, Stuttgart, pp 51–63

    Google Scholar 

  11. Müller A, Rüegsegger E, Rüegsegger P (1989) Peripheral QCT: a low-risk procedure to identify woman predisposed to osteoporosis. Phys Med Biol 34: 741–749

    Google Scholar 

  12. Faulkner KG, Glüer CC, Majumdar S, Lang P, Engelke K, Genant HK (1991) Non-invasive measurements of bone mass, structure and strength: current methods and experimental techniques. AJR 157: 1229–1237

    Google Scholar 

  13. Johnston CC, Slemenda CW, Melton LJ III (1991) Clinical use of bone densitometry. N Engl J Med 324: 1105–1109

    Google Scholar 

  14. Schneider P, Börner W, Mazess RB, Barden H (1988) The relationship of peripheral to axial bone density. Bone Miner 4: 279–287

    Google Scholar 

  15. Reiners Chr, Arnold B, Brust AS, Sonnenschein W (1990) Precision of bone mineral measurement with the new QCT scanner Stratec SCT 900. J Nucl Med 31: 856

    Google Scholar 

  16. Liebermann E, Heuser E, Gilchrist GS, Donnell GN, Landing BH (1968) Thrombosis, nephrosis, and corticosteroid therapy. J Pediatr 73: 320–328

    Google Scholar 

  17. Ehrich JHH, Brodehl J, Arbeitsgemeinschaft für Pädiatrische Nephrologie (1993) Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Eur J Pediatr 152: 357–361

    Google Scholar 

  18. Saxena KM, Crawford JD (1965) The treatment of nephrosis. N Engl J Med 272: 522–526

    Google Scholar 

  19. Lukert BP, Raisz LG (1990) Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 112: 352–364

    Google Scholar 

  20. Dambacher MA, Olah AJ, Maurer H, Gampp R, Rüegsegger P (1990) Pathogenese, Prophylaxe und Therapie der Steroid-Osteoporose. Z Orthop 128: 234–239

    Google Scholar 

  21. Adinoff AD, Hollister JR (1982) Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med 309: 265–268

    Google Scholar 

  22. Rüegsegger P, Medici TC, Anliker M (1983) Corticosteroid-induced bone loss. A longitudinal study of alternate day therapy in patients with bronchial asthma using quantitative computed tomography. Eur J Clin Pharmacol 25: 615–620

    Google Scholar 

  23. Foote KD, Brocklebank JT, Meadow SR (1985) Height attainment in children with steroid-responsive nephrotic syndrome. Lancet II: 917–919

    Google Scholar 

  24. Chesney RW, Mazess RB, Rose P, Jax DK (1978) Effect of prednisone on growth and bone mineral content in childhood glomerular disease. Am J Dis Child 132: 768–772

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lettgen, B., Jeken, C. & Reiners, C. Influence of steroid medication on bone mineral density in children with nephrotic syndrome. Pediatr Nephrol 8, 667–670 (1994). https://doi.org/10.1007/BF00869084

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00869084

Key words

Navigation