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

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 z-scores 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.