Bone Mineral Density in Children with Nephrotic Syndrome Treated under GC for More than 2 Years

Nephrotic Syndrome (NS), common in the pediatric population is typically treated with high-dose glucocorticoid (GC). Long-term GC treatment in refractory cases results in osteoporosis susceptibility. Immunosuppressants adjuvant to GC, used to induce remission in steroid-resistant NS, have shown controversial effects on bone density. This study aims to evaluate and compare bone density in children with NS undergoing GC therapy for ≥2 years with or without immunosuppression using DEXA.

Twenty-three NS patients were enrolled in the study and underwent DXA scan. Demographic data and years of disease, and electrolytes including calcium, phosphorus, and vitamin D levels, as well as creatinine, Glomerular Filtration Rate (GFR), and albumin were documented.

DEXA scan showed low bone density in 4 out of 23 participants (17.4%), two of whom had scores lower than -2, which is indicative of osteoporosis, 2 of whom received cyclosporine and one received tacrolimus adjuvant therapy. Disease chronicity was significantly higher in children with lower whole-body Z-scores. Lower than normal vitamin D levels were detected in 68% of cases.

Our observations revealed a 2:1 ratio of cyclosporine to tacrolimus use in patients in Z-score <-1. We suggest that pediatric patients undergoing ≥2 years of GC therapy, especially in high doses or adjuvant to immunosuppressants, be screened for bone loss using DEXA scan for timely diagnosis and management. Furthermore, clinicians should be aware of the beneficial effects of vitamin D supplements in long-term GC therapy and evaluate their patients for vitamin D and calcium deficiency.