Factors influencing cardiovascular risk following termination of glucocorticoid therapy for nephrotic syndrome
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This study attempted to identify the cardiovascular risk factors associated with retention of excess weight following termination of glucocorticoid therapy in children with nephrotic syndrome.
We performed a retrospective study of 30 Japanese children (18 males, 12 females, aged 1–14 years) who had been treated with glucocorticoids for steroid-sensitive nephrotic syndrome and 32 control children (17 males, 15 females, aged 1–15 years). The subjects receiving glucocorticoid therapy were divided into a retention group (n = 14) or a reduction group (n = 16) on the basis of the presence or absence of a maintained body mass index (BMI) following glucocorticoid termination. BMI z-scores, age, gender, blood pressure, serum total cholesterol levels (T-cho), and the dose and duration of glucocorticoid exposure were evaluated in each group during the study period.
The retention group had a significantly (P < 0.05) increased dose and duration of glucocorticoid exposure, and of T-cho at the time of last visit compared with the control or reduction group. Moreover, logistic regression analysis showed that the adjusted odds ratio for T-cho at the time of last visit in the retention group was significantly higher (P < 0.05) relative to the reduction group.
Retention of excess weight during the period of remission from nephrotic syndrome following cessation of glucocorticoid therapy was related to the dose and duration of glucocorticoid exposure and was associated with hyperlipidemia, which might enhance cardiovascular risk.
KeywordsClinical nephrology Cortisol Lipids Nephrotic syndrome Obesity
We are very grateful for support from the Mitsui Life Social Welfare Foundation and Mitsukoshi Welfare Foundation. We thank Dr. Kouhei Uemura in the Department of Epidemiology and Biostatistics in University of Tokyo, Tokyo, Japan, for assistance with statistical analysis. We also thank Prof. E. J. Johns, Department of Physiology, University of Cork, Ireland, for critical review of the manuscript and suggestions.
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