Impact of childhood nephrotic syndrome on obesity and growth: a prospective cohort study

Cal H Robinson; Nowrin Aman; Tonny Banh; Josefina Brooke; Rahul Chanchlani; Vaneet Dhillon; Valerie Langlois; Leo Levin; Christoph Licht; Ashlene McKay; Damien Noone; Alisha Parikh; Rachel Pearl; Seetha Radhakrishnan; Veronique Rowley; Chia Wei Teoh; Jovanka Vasilevska-Ristovska; Rulan S Parekh

doi:10.1007/s00467-024-06370-0

Impact of childhood nephrotic syndrome on obesity and growth: a prospective cohort study

Pediatr Nephrol. 2024 Apr 18. doi: 10.1007/s00467-024-06370-0. Online ahead of print.

Authors

Cal H Robinson^{1

2

3}, Nowrin Aman³, Tonny Banh³, Josefina Brooke¹, Rahul Chanchlani^{4

5}, Vaneet Dhillon¹, Valerie Langlois⁶, Leo Levin^{1

2}, Christoph Licht^{1

2

7}, Ashlene McKay^{1

2}, Damien Noone^{1

2}, Alisha Parikh³, Rachel Pearl^{1

2

8}, Seetha Radhakrishnan^{1

2}, Veronique Rowley³, Chia Wei Teoh^{1

2}, Jovanka Vasilevska-Ristovska³, Rulan S Parekh^{9

10

11

12}

Affiliations

¹ Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.
² Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada.
³ Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁴ Division of Nephrology, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada.
⁵ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁶ Division of Nephrology, Department of Paediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada.
⁷ Program in Cell Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁸ Division of Nephrology, William Osler Health Systems, 20 Lynch Street, Brampton, Ontario, L6W 2Z8, Canada.
⁹ Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada. rulan.parekh@wchospital.ca.
¹⁰ Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada. rulan.parekh@wchospital.ca.
¹¹ Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. rulan.parekh@wchospital.ca.
¹² Department of Medicine, Women's College Hospital and University of Toronto, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada. rulan.parekh@wchospital.ca.

PMID: 38637343
DOI: 10.1007/s00467-024-06370-0

Abstract

Background: Children with nephrotic syndrome are at risk of obesity and growth impairment from repeated steroid treatment. However, incidence and risk factors for obesity and short stature remain uncertain, which is a barrier to preventative care. Our aim was to determine risk, timing, and predictors of obesity and short stature among children with nephrotic syndrome.

Methods: We evaluated obesity and longitudinal growth among children (1-18 years) enrolled in Insight into Nephrotic Syndrome: Investigating Genes, Health, and Therapeutics. We included children with nephrotic syndrome diagnosed between 1996-2019 from the Greater Toronto Area, Canada, excluding congenital or secondary nephrotic syndrome. Primary outcomes were obesity (body mass index Z-score ≥ + 2) and short stature (height Z-score ≤ -2). We evaluated prevalence of obesity and short stature at enrolment (< 1-year from diagnosis) and incidence during follow-up. Cox proportional hazards models determined the association between nephrotic syndrome classification and new-onset obesity and short stature.

Results: We included 531 children with nephrotic syndrome (30% frequently relapsing by 1-year). At enrolment, obesity prevalence was 23.5%, 51.8% were overweight, and 4.9% had short stature. Cumulative incidence of new-onset obesity and short stature over median 4.1-year follow-up was 17.7% and 3.3% respectively. Children with frequently relapsing or steroid dependent nephrotic syndrome within 1-year of diagnosis were at increased risk of new-onset short stature (unadjusted hazard ratio 3.99, 95%CI 1.26-12.62) but not obesity (adjusted hazard ratio 1.56, 95%CI 0.95-2.56). Children with ≥ 7 and ≥ 15 total relapses were more likely to develop obesity and short stature, respectively.

Conclusions: Obesity is common among children with nephrotic syndrome early after diagnosis. Although short stature was uncommon overall, children with frequently relapsing or steroid dependent disease are at increased risk of developing short stature. Effective relapse prevention may reduce steroid toxicity and the risk of developing obesity or short stature.

Keywords: Childhood; Growth; Nephrotic syndrome; Obesity; Pediatric; Short stature.