Published: 2017-05-23

Pattern of adverse effects in patients with nephrotic syndrome on oral prednisolone

Shankareswari S., Jayapriya B., Balamurugan P. V., Lourdu Jafrin A., Geetha K.


Background: Nephrotic syndrome is a common illness affecting the paediatric age group and 80% of the idiopathic syndrome is steroid sensitive. Multiple relapses make them vulnerable to the adverse effects of corticosteroids. There is limited literature evidence for the adverse effects of steroids in children with renal pathology.

Methods: This descriptive, cross sectional study analyses the adverse effects of oral prednisolone in children and adults with nephrotic syndrome Fifty-five patients with nephrotic syndrome, attending nephrology or paediatric OP, more than 3 years of age and who were on oral prednisolone for a minimum of eight weeks were included in the study. Demographic details, detailed history, lab investigations and ophthalmic examination were done and the results were analysed.

Results: Hypertension and behavioural changes were the most common adverse effects followed by dermatological, endocrine and metabolic changes. Infections and gastrointestinal disturbances were more in adults (p <0.05). Short stature was more in children (p< 0.05). There was no abnormality in blood glucose levels and body weight. Hypertension, cushingoid habitus, infections and short stature were statistically less in patients on alternate day prednisolone. But no statistical association could be made between the occurrence of cataract and the pattern of prednisolone use.

Conclusions: Adverse effects pattern is different among adults and children. Also, the adverse effects are less with alternate day prednisolone regimen. Long term follow up into their adulthood is needed to analyse the morbidity produced by corticosteroids in these subsets of population.


Adverse effects, Alternate day therapy, Corticosteroids, Nephrotic syndrome, Prednisolone

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Hodson EM, Knight JF, Willis NS, Craig JC. Corticosteroid therapy in nephrotic syndrome: a meta-analysis of randomised controlled trials. Arch Dis Child. 2000;83:45-51.

2000 CDC Growth charts for the United states: Methods and Development. Series 11, No. 246, http:// growth charts / cdc charts html.

Falkner B, Daniels SR, Flynn JT, Gidding S, Green LA, Ingelfinger JR et al. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatr. 2004;114:555-76.

Powers AC. Diabetes milletus. In: Harrisons principles of internal medicine. New York [etc]: McGraw-Hill; 2012.

Kodner C. Nephrotic Syndrome in Adults: Diagnosis and Management. Am Fam Physician. 2009;80(10):1129-34.

Cameron JS. The nephrotic syndrome: Management, complications and pathophysiology. In (eds): Alex M, Davidson J, Cameron S, Pierre J, Girinfeld, Kerr DNS, Ritz E, Christopher G. Winerals Oxford text book of Clinical nephrology, 2nd ed. Oxford Publication. 1998;1:461-92.

Shome GP, Sakauchi M, Yamane K, Takemura H, Kashiwagi H. Ischemic heart disease in systemic lupus erythematosus. a retrospective study of 65 patients treated with prednisolone. Japanese J Med. 1989;28(5):599-603.

Minetto MA, Botter A, Lanfranco F, Baldi M, Ghigo E, Arvat E. Muscle fiber conduction slowing and decreased levels of circulating muscle proteins after short-term dexamethasone administration in healthy subjects. J Clin Endocrinol Metab. 2010;95(4):1663-71.

Girod JP, Brotman DJ. Does altered glucocorticoid homeostasis increase cardiovascular risk? Cardiovascular Res. 2004;64: 217-26.

Peppa M, Krania M, Raptis SA. Hypertension and other morbidities with Cushing’s syndrome associated with corticosteroids: a review. Integr Blood Press Control. 2011;4(3):7-16.

Seth A, Aggarwal A. Monitoring adverse reactions to steroid Therapy in Children. Indian Pediatr. 2004,;41:349-57.

Patel L, Clayton PE, Jenney ME, Ferguson JE, David TJ. Adult height in patients with childhood onset atopic dermatitis. Arch Dis Child 1997;76:505-8.

Zhou X, Loke KY, Pillai CC, How HK, Yap HK, Lee KO. IGFs and IGF-binding proteins in short children with steroid-dependent nephrotic syndrome on chronic glucocorticoids: changes with 1 year exogenous GH. Europ J Endocrinol .2001;144:237-43.

Allen DB, Julius JR, Breen TJ, Attie KM. Treatment of Glucocorticoid-Induced Growth Suppression with Growth Hormone. J Clin Endocrinol Metab. 1998;83:2824-9.

Carter ME, James VH. Effect of alternate-day, single dose, corticosteroid therapy on pituitary-adrenal function. Ann Rheum Dis. 1972;31:379-83.

Greenstone MA, Shaw AB. Alternate day corticosteroid causes alternate day hyperglycaemia. Postgraduate Med J. 1987;63:761-4.

Yamashita F, Funatsu T, Nagayama K, Arihiro H, Anan S. Evaluation of alterntae-day steroid therapy for nephrotic syndrome in childhood. Kurume Med J. 1971;18(3):153-60.

Wales JK, Milner RD. Variation in lower leg growth with alternate day steroid treatment. Arch Disea Childhood. 1988;63(8):981-3.

Langman MJ, Lancashire RJ, Cheng KK, Stewart PM. Systemic hypertension and glaucoma: mechanisms in common and co-occurrence. Br J Ophthalmol. 2005;89;960-3.