Metabolic Bone Disease in Children with Idiopathic Nephrotic Syndrome

Children with idiopathic nephrotic syndrome (INS) may be at risk for metabolic bone disease (MBD) because of biochemical derangements caused by the renal disease, as well as the corticosteroid effects on bone. We studied 70 children with INS for clinical, biochemical, and radiological evidence of MBD. These patients were divided into two groups: 55 frequent relapsers (FR; group I), and 15 infrequent relapsers (IFR; group II). Thirty healthy children matched for age and sex constituted the control group. Bone mineral density (BMD) of these children was evaluated by the Achilles Express Quantitative Ultrasound (QUS) device. Univariate and multivariate analyses were performed to analyze factors predictive of low BMD T- score. We observed that nephrotic children had significantly lower mean BMD T- scores compared with controls (-1.99 +/- 0.74 versus -0.39 +/- 0.87; P = <0.0001). Also, children in group I were found to have significantly lower mean BMD T- scores compared with group II (-2.1 +/- 0.67 versus -1.31 +/- 0.64; P = <0.0001). We also observed that 32.7% of group I had osteoporosis compared to none of group II (P= 0.01). Significantly higher doses of steroids over longer duration of therapy were administered to group I compared with group II (P = < 0.0001 and 0.0004 respectively). On multivariate analysis, the only factor found to be predictive of a low BMD T- score was greater cumulative steroid dose (P= 0.02). We concluded that children with INS are at risk for MBD, especially those receiving higher doses of steroids. Regular BMD evaluation and appropriate therapeutic interventions are recommended for these children. The role of prophylactic therapy in such patients needs to be further investigated. [Naglaa F. Boraey, Ahmad Addosooki, Mohammad A. Mohammad; Marwa M. El-Sonbaty, Safinaz E. El-Toukhy. Metabolic Bone Disease in Children with Idiopathic Nephrotic Syndrome. Life Sci J 2012;9(4):275-280]. (ISSN:1097-8135). http://www.lifesciencesite.com. 40