Bone densitometry in children with nephrotic syndrome / Mohamed Mohamed Elsayed Elkenany ; Supervised Samuel Helmi Makar , Doaa Mohamed Salah , Engy Adel Ali

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Pediatrics

Background: Childhood nephrotic syndrome is one of the most frequent glomerular diseases among children. Steroid therapy is known to be the standard treatment .The aim of this study is to assess bone density in children with nephrotic syndrome and to correlate degree of bone density affection with steroid therapy as regard dose and duration. Methods: The study included 50 children with nephrotic syndrome (25 SDNS/FRNS and 25 IFRNS). Clinical, laboratory assessment and bone mineral density (BMD) was measured using dual energy X-ray absorptiometry for all included cases. Results: BMD abnormality is significantly increased in SDNS/FRNS group than IFRNS group (p=0.001). BMD abnormality positively correlates with frequent relapsers/year (p=0.001). There was highly significant impaired linear growth (<3rd centile for height) in nephrotic patients with abnormal BMD compared to nephrotic patient with normal BMD (p=0.001), bone ache is the only significant complain in NS children with abnormal BMD than with normal BMD (p=0.004). The best cut off point between nephrotic children with normal BMD and abnormal BMD regarding cumulative dose was found >8329.4 mg/m² with sensitivity of 85% and specificity of 96.67% and area under curve (AUC) of 92%. Un-standardized and standardized linear regression coefficients for correlations between BMD Z-score and Steroid cumulative dose, duration and age of diagnosis show the steroid cumulative dose and duration were significant risk factor for low BMD Z-score and abnormal BMD. Conclusion: Steroid therapy in large cumulative dose and longer duration can leads to decrease in BMD and increase risk of fracture even without evident clinical manifestation to fractures

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