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18-04-2024 | Nephrotic Syndrome | Original Article

Impact of childhood nephrotic syndrome on obesity and growth: a prospective cohort study

Authors: Cal H. Robinson, Nowrin Aman, Tonny Banh, Josefina Brooke, Rahul Chanchlani, Vaneet Dhillon, Valerie Langlois, Leo Levin, Christoph Licht, Ashlene McKay, Damien Noone, Alisha Parikh, Rachel Pearl, Seetha Radhakrishnan, Veronique Rowley, Chia Wei Teoh, Jovanka Vasilevska-Ristovska, Rulan S. Parekh

Published in: Pediatric Nephrology

Abstract

Background

Children with nephrotic syndrome are at risk of obesity and growth impairment from repeated steroid treatment. However, incidence and risk factors for obesity and short stature remain uncertain, which is a barrier to preventative care. Our aim was to determine risk, timing, and predictors of obesity and short stature among children with nephrotic syndrome.

Methods

We evaluated obesity and longitudinal growth among children (1–18 years) enrolled in Insight into Nephrotic Syndrome: Investigating Genes, Health, and Therapeutics. We included children with nephrotic syndrome diagnosed between 1996–2019 from the Greater Toronto Area, Canada, excluding congenital or secondary nephrotic syndrome. Primary outcomes were obesity (body mass index Z-score ≥ + 2) and short stature (height Z-score ≤ -2). We evaluated prevalence of obesity and short stature at enrolment (< 1-year from diagnosis) and incidence during follow-up. Cox proportional hazards models determined the association between nephrotic syndrome classification and new-onset obesity and short stature.

Results

We included 531 children with nephrotic syndrome (30% frequently relapsing by 1-year). At enrolment, obesity prevalence was 23.5%, 51.8% were overweight, and 4.9% had short stature. Cumulative incidence of new-onset obesity and short stature over median 4.1-year follow-up was 17.7% and 3.3% respectively. Children with frequently relapsing or steroid dependent nephrotic syndrome within 1-year of diagnosis were at increased risk of new-onset short stature (unadjusted hazard ratio 3.99, 95%CI 1.26–12.62) but not obesity (adjusted hazard ratio 1.56, 95%CI 0.95–2.56). Children with ≥ 7 and ≥ 15 total relapses were more likely to develop obesity and short stature, respectively.

Conclusions

Obesity is common among children with nephrotic syndrome early after diagnosis. Although short stature was uncommon overall, children with frequently relapsing or steroid dependent disease are at increased risk of developing short stature. Effective relapse prevention may reduce steroid toxicity and the risk of developing obesity or short stature.

Graphical abstract

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Title: Impact of childhood nephrotic syndrome on obesity and growth: a prospective cohort study
Authors: Cal H. Robinson
Nowrin Aman
Tonny Banh
Josefina Brooke
Rahul Chanchlani
Vaneet Dhillon
Valerie Langlois
Leo Levin
Christoph Licht
Ashlene McKay
Damien Noone
Alisha Parikh
Rachel Pearl
Seetha Radhakrishnan
Veronique Rowley
Chia Wei Teoh
Jovanka Vasilevska-Ristovska
Rulan S. Parekh
Publication date: 18-04-2024
Publisher: Springer Berlin Heidelberg
Keywords: Nephrotic Syndrome
Obesity
Obesity
Overweight
Published in: Pediatric Nephrology
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-024-06370-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of childhood nephrotic syndrome on obesity and growth: a prospective cohort study

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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