Correlation between Corticosteroid Therapy and Height in Childhood Nephrotic Syndrome: A Systematic Review

Document Type : Systematic Review


1 School of Medicine, Universitas Airlangga, Surabaya, Indonesia

2 Department of Child Health, Dr. Soetomo General Hospital Surabaya, Indonesia

3 Departement of Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia


Introduction: Nephrotic syndrome is a clinical manifestation of glomerular  disease characterized by severe or nephrotic-range proteinuria >3.5 g/24 hours. The treatment of nephrotic syndrome using corticosteroid especially prednisone, belongs to a class of glucocorticoid. Glucocorticoids are proven  to be  able to inhibit growth through several mechanisms.  The objective of this study  was  to  analyze  the  characteristic  of  height  in  childhood  nephrotic syndrome  and  analyze  the  correlation  between corticosteroid therapy and height in childhood nephrotic syndrome.
Methods:  This systematic review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)  guideline.  The  literature  search  was  conducted  in  November  2020  in  four  databases:  PubMed,  Science  Direct, Scopus, and DOAJ. Quality assessment was carried out using a quality assessment tool for quantitative studies from EPHPP.
Results: Six studies met the inclusion criteria for final analysis.  The mean final height z-scores were -0.66 ± 3.04. The height z-scores of Steroid-Dependent Nephrotic Syndrome (SDNS) (-0.33 ± 0.87) and Steroid-Resistant Nephrotic Syndrome (SRNS) (-0.97  ±  1.34)  patients  were  lower  than  Steroid-Sensitive  Nephrotic  Syndrome  (SSNS)  (-0.20  ±  3.14)  patients.  The height  zscores of nephrotic syndrome children were significantly lower than a normal population.  Five studies suggested that there is a correlation  between  corticosteroid  therapy  and  height  on  childhood  nephrotic syndrome  and  one  study  did  not  find  a correlation between them.
Conclusion:  According  to  findings,  there  is  a  negative  correlation  between  corticosteroid  therapy  and  height  in childhood nephrotic syndrome. Nephrotic syndrome children had significantly lower height z-scores than a normal population. The SDNS and  SRNS  patients  are  more  susceptible  to  have  a  lower  height  than  SNSS  patients  as  they  have  a  higher  cumulative corticosteroid dose.