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Pediatric Nephrology

26-04-2024 | Nephrotic Syndrome | Original Article

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

Authors: 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, Members of the Nephrotic Syndrome Study Network (NEPTUNE)

Published in: Pediatric Nephrology

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Abstract

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

Appendix
Available only for authorised users
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Metadata
Title
Growth in children with nephrotic syndrome: a post hoc analysis of the NEPTUNE study
Authors
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
Members of the Nephrotic Syndrome Study Network (NEPTUNE)
Publication date
26-04-2024
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-024-06375-9