Steroid Therapy In Children Research Articles

Serum tumour necrosis factor-alpha as a marker of disease activity in children with nephrotic syndrome.

Idiopathic nephrotic syndrome (NS) is a common glomerular disease in children throughout the world; however, the exact pathogenesis of the disease remains unknown. Several studies have shown that tumour necrosis factor-alpha (TNF-α), a proinflammatory cytokine, plays a significant role in the pathogenesis of NS. The literature lacks sufficient data to establish the relationship between TNF-α and NS. This prospective study was conducted on children aged 1-14 years diagnosed with idiopathic NS. All enrolled individuals were followed up from disease onset or relapse of NS until remission or at least 42 days with steroid therapy if remission was not achieved. Serum TNF-α levels were measured at presentation and remission or after 42 days of steroid therapy if remission was not achieved. The role of TNF-α levels in response to steroid therapy in NS was also assessed. One hundred and twelve children (68% boys) with idiopathic NS were enrolled. The median age (interquartile range) at enrolment was 58.5 (37-84.7) months, while the median age at symptom onset was 47.5 (24-60.7) months. The median TNF-α level at presentation was 7.5 (3.5-12.1) pg/ml, and that at remission was 5.25 (1.62-8.8) pg/ml. The median TNF-α levels among first-episode NS at presentation were 3.98 pg/ml and 1.88 pg/ml (P = .04) at remission, whereas in steroid-resistant NS, it was 6.59 pg/ml at presentation and 9.02 pg/ml at 42 days (P = .45). There was a significant negative correlation between the duration of steroid therapy and TNF-α levels, with a correlation factor of -0.021 and R2 of 0.154 (P≤.001). Serum TNF-α levels decrease with steroid therapy in children with steroid-sensitive NS, which correlates clinically with the achievement of remission.

Experience of using inhaled steroid therapy in children with whooping cough

The aim of study: аnalysis of the effectiveness of inhaled steroid therapy in patients with whooping cough.Materials and methods: 74 patients with whooping cough were observed, among whom 40 children included inhalations with Budesonide in complex therapy (main group). 34 patients in the comparison group received only basic therapy. The age structure in the main group was as follow: тhere were children under one years old 18 (47.4 ± 8.1%), 1—3 years — 7 (18.4 ± 6.3%); 4—6 years — 8 (21 ± 6.6%), 7—14 years — 7 (13.2 ± 5.5%) and comparable to the comparison group. To verify whooping cough were used the PCR method and serological diagnostic (IFA) using a test system “Ridascreen/Bordetella pertussis («R-biofarm AMG», Germany). Results: budеsonide was prescribed for a course of 5—7 days. Clinical analysis of dynamics of cough in main group showed, that a reduction in a number of attacks by the 4—5th day of budesonide was observed in majority of children (35/87.5 ± 5.2%). In the main group coughing attacks with a frequency of more than 15—25 times a day persisted for 2.7 ± 0.2 days, and in comparison group — 4.3 ± 0.2 (p < 0.001). Relief of broncho-obstructive syndrome was observed in shorter period of time, which contributes to a reduction in the average length of stay of the patient in the hospital.

Glucocorticoid Sensitivity in vitro can predict the Clinical Response to Steroid Therapy in Children with Idiopathic Nephrotic Syndrome

Glucocorticoid Sensitivity in vitro can predict the Clinical Response to Steroid Therapy in Children with Idiopathic Nephrotic Syndrome

Clinical Characteristics and Effects of Steroid Therapy in Children with Acute Cerebellar Ataxia

Clinical Characteristics and Effects of Steroid Therapy in Children with Acute Cerebellar Ataxia

Steroid therapy in children with IgA nephropathy.

IgA nephropathy (IgAN) is one the most common primary glomerulonephritis in children and adolescents worldwide, with 20% of children developing end-stage kidney disease (ESKD) within 20years of diagnosis. There is a need for treatment guidelines, especially for steroids in children with primary IgAN, since the STOP-IgA trial casts doubts on the use of steroids in adults with intermediate risk. Pediatricians are prone to prescribe steroids in addition to renin-angiotensin system blockade (RASB) when proteinuria is > 0.5g/l, eGFR deteriorates < 70ml/min/1.73m2, or when a biopsy sample shows glomerular inflammation. Lack of randomized controlled trials (RCTs) in children with IgAN has led to an absence of consensus on the use of immunosuppressive agents in the treatment of progressive IgAN. This literature review evaluates the available evidence on steroid treatment in children with IgAN.

Steroid therapy in children with fulminant hepatitis A.

Fulminant hepatic failure is a life-threatening disease. Hepatitis A virus (HAV) can cause fulminant hepatic failure and death in about 0.2% of cases. Extensive destruction of infected hepatocytes by immune-mediated lysis is thought to be the cause. We aimed to evaluate the use of steroid therapy in children with fulminant HAV. This study included 33 children with fulminant HAV in two groups. Steroid group: comprised of 18 children who received prednisolone (1mg/kg/d) or its equivalent dose of methylprednisolone, and the nonsteroid group: comprised another 15 children who did not receive steroid therapy. Age and sex were matched for both groups (P>.05), and they were comparable regarding baseline clinical and laboratory characteristics. Of the steroid group, 15 patients survived and 3 died, while in the nonsteroid group, 4 patients survived and 11 died (P=.001). Of the living patients, 15 of 19 (78.9%) received steroids while only 3 of 14 (21.4%) of the dead patients received steroids (P=.001). Stepwise regression analysis showed that steroid therapy was the only independent variable associated with recovery (P=.001). Steroid therapy in children with fulminant HAV associated significantly with improved outcome and survival. Future studies on a larger population size are strongly recommended.

SAFETY AND EFFICACY OF INTRAVENOUS PULSE CYCLOPHOSPHAMIDE THERAPY IN CHILDREN WITH STEROID-DEPENDENT NEPHROTIC SYNDROME

Background: Cyclophosphamide (Cyp) is a well-known alternative agent to spare the use of steroids and avoid the side effects that result from long-term steroid therapy in children with idiopathic nephrotic syndrome (NS). Use of Cyp typically reduces the risk of relapse in comparison with prednisolone by about 50%. Objective: To study the safety and efficacy of intravenous pulse Cyp (IV Cyp) therapy in children with steroid-dependent NS (SDNS). Materials and Methods: This was a retrospective single-center analysis from a large government hospital in South India. The data were retrieved from the records of children attending the pediatric nephrology clinic between 2005 and 2016. Children with SDNS who received the complete schedule of IV Cyp were included in the study. Children who received other alternate drugs were excluded. Results: Fifty patients with SDNS were treated with IV Cyp, seven patients did not complete the treatment and were excluded from the analysis. 24 (56%) of the 43 patients stayed in remission throughout the course of Cyp treatment and prednisolone could be stopped and were considered as Cyp responsive. The remaining 19 (44%) children had relapsed while on Cyp therapy (Cyp resistant) and required treatment with alternate immunosuppressant drugs. 19 of the 24 Cyp responsive patients were in remission 6 months after stopping Cyp treatment (Cyp sensitive) while the remaining five patients relapsed within 6 months of stopping Cyp treatment (Cyp dependent). 9 children (20.9%) were relapse-free till the time of last follow-up with a median follow-up of 2.1 years. Among 24 children, 13 (30.23%) who responded were infrequently relapsing NS and 2 (4.5%) children were frequently relapsing NS.

Sensitivity or resistance to steroid therapy in children with idiopathic nephrotic syndrome is not associated with polymorphism of angiotensin converting enzyme (ACE)

Sensitivity or resistance to steroid therapy in children with idiopathic nephrotic syndrome is not associated with polymorphism of angiotensin converting enzyme (ACE)

Polymorphic variants of MIF gene and prognosis in steroid therapy in children with idiopathic nephrotic syndrome.

Nephrotic syndrome (NS) is the most common reason of proteinuria in children and can be caused by the pathology of renal glomeruli. Steroid therapy is typically used in this disorder. It has been shown that MIF is a cytokine which counteracts the immunosuppressive properties of glucocorticoids. The aim of this study was looking for a correlation between MIF polymorphisms and genetic susceptibility to steroid resistance in children with INS (Idiopathic NS). The study was performed in 71 patients with INS including SRNS (steroid resistance nephrotic syndrome) (41) and SSNS (steroid sensitive nephrotic syndrome) (30) and in 30 control subjects. We employed Sanger sequencing and capillary electrophoresis. Linkage disequilibrium was made using Haploview and PHASE. We didn't observe a statistical significance between SNPs detected in patients with INS and controls. Our studies revealed statistical significance for two polymorphisms: rs2070767C > T and rs2000466T > G between patients with SRNS and SSNS. The results for rs34383331T > A are close to being statistically significant. Statistical significance was revealed for CATT5/CATT6 genotype in SRNS group vs SSNS group (OR=4.604, 95%CI=1.356-15.632, p=0.0168). We found that the frequency of 5/X-CATT genotype compared with X/X-CATT genotype was significantly higher in SRNS patients vs SSNS (OR=3.167, 95%CI=1.046-9.585, p=0.0426). In linkage disequilibrium analysis we didn't show involvement in susceptibility to INS and steroid sensitive phenotype. Our results suggest that the role of MIF polymorphisms in the susceptibility to positive response to steroid therapy is still unresolved. It indicates that MIF may be involved in indirect and complex molecular mechanisms of steroid activity in hormone-dependent metabolic pathways in children with INS. Because of ambiguous findings, pleiotropic features of this cytokine require that more research should be undertaken.

Comparison of the Therapeutic Efficacy of Methylprednisolone Pulse Therapy and Oral Steroid Therapy in Children with IgA Nephropathy and HSP Nephritis Combined with Proteinuria

Comparison of the Therapeutic Efficacy of Methylprednisolone Pulse Therapy and Oral Steroid Therapy in Children with IgA Nephropathy and HSP Nephritis Combined with Proteinuria

Ultrasound velocity through the tibia is not affected by prolonged inhaled steroid therapy in children

To evaluate in a prospective, cross-sectional cohort study the impact of inhaled corticosteroids (ICS) on bone speed of sound (SOS) in asthmatic children. Children with mild-to-moderate asthma from a pulmonary clinic were assessed over a 2-month period. We recorded clinical and demographic data related to asthma severity, its treatment, participation in sports and dairy intake. Tibial SOS was measured using the Sunlight Omnisense 7000S quantitative ultrasound bone sonometer. Eighty-five mild-to-moderate asthmatic children were studied. Age range was 1.4-17 years (71.7% boys). Average disease duration was approximately 5 years, and the average cumulative duration of ICS therapy was approximately 1.5 years. Average SOS Z-score was slightly negative and varied between -3.5 and +1.9 SD. In univariate analysis, SOS Z-score was negatively correlated with asthma duration (R(2) = 5.7%, p = 0.028) and ICS duration (R(2) = 4.9%, p = 0.042). In backward stepwise multiple regression, where SOS Z-score was the dependent variable, the only variables that remained significant in the final analysis were gender (p = 0.015), asthma duration (p = 0.003) and BMI (p = 0.048) (R(2) for the model 17.52% p = 0.01). Prolonged inhaled steroid therapy appears to have no deleterious effect upon SOS in children with mild-to-moderate persistent asthma.

Adverse Effects of Steroid Therapy in Children With Pharyngitis With Unsuspected Malignancy

Pharyngitis is a common clinical complaint for children and accounts for 3.1% of all visits to selected ambulatory care settings. Most children with pharyngitis have benign, self-limited disease with infrequent complications such as peritonsillar abscess, mastoiditis, or lymphadenitis. Recent studies have touted the benefits of steroids in the treatment of children with pharyngitis for pain control. These studies do not address the potential life-threatening complication of steroids in patients with pharyngitis or lymphadenopathy in the setting of undiagnosed acute lymphocytic leukemia (ALL) or lymphoma. We report 4 cases of children treated with steroids for pharyngitis or adenitis that subsequently were diagnosed with ALL or lymphoma. If steroids are to be used in children with pharyngitis or adenitis, the following recommendations should be strongly considered: Careful history and physical examination should be obtained. Presence of hepatosplenomegaly or lymphadenopathy outside the cervical region should raise suspicions regarding an underlying malignancy. Normal results of complete blood cell count in the setting of clear cut pharyngitis with exudates and a lack of significant adenopathy essentially rules out the diagnosis of ALL. Because traditional analgesics are available, which do not affect the curability of ALL or lymphoma, the routine use of steroids in pharyngitis in children should be considered only in rare circumstances.

Long-term steroid treatment and growth: a study in steroid-dependent nephrotic syndrome

ObjectiveHigh-dose steroid therapy in children is known to impair growth. What is unknown is the level of steroid therapy at which children continue to grow normally. This study was designed...

Long-term Corticosteroid Use

Long-term Corticosteroid Use

Cyclosporine and steroid therapy in children with steroid-resistant nephrotic syndrome

We conducted a prospective, multicenter trial to evaluate the efficacy and safety of a 12-month course of cyclosporine in children with steroid-resistant nephrotic syndrome (SRNS). Thirty-five patients were enrolled, of whom 28 had minimal change or diffuse mesangial proliferation (MC/DMP), and seven had focal segmental glomerulosclerosis (FSGS). All patients received cyclosporine and prednisolone; patients with FSGS additionally received methylprednisolone pulse therapy (MPT). The dose of cyclosporine was adjusted to maintain a trough level of 120-150 ng/ml during the initial 3 months of treatment, followed by 80-100 ng/ml during months 4-12. The primary end point was the remission rate at month 12. Remission was achieved in 23 of 28 (82.1%) patients in the MC/DMP group and in six of the seven (85.7%) patients in the FSGS group. Follow-up renal biopsies were performed in 26 patients (nine at month 12, 17 at month 24), and cyclosporine-related nephrotoxicity was detected in one (3.8%). Major adverse events comprised severe bacterial infections (two patients) and posterior reversible encephalopathy syndrome (one patient). In conclusion, a high remission rate was achieved in our patient cohort using a combined cyclosporine/ prednisolone treatment regimen in children with SRNS who had MC/DMP and a combined cyclosporine/prednisolone plus MPT regimen in children who had FSGS.

Steroid therapy in children with tuberculous meningitis

We present 7 children with TBM (3 children who received a higher dose of steroids and and 4 children who received prednisolone at 2 mg/kg/d). Patients with high-dose steroids had no new tuberculomas on follow-up whereas all those on a regular dose of steroids developed tuberculomas within 2-8 months of therapy.

Frequent methylprednisone pulse therapy is a risk factor for steroid cataracts in children

Pediatricians use corticosteroids for prolonged periods of time for the treatment of many diseases, including rheumatic disease. The side-effects of corticosteroids, especially cataracts, are widely recognized, but the predictive risk factors for steroid-induced cataracts have not yet been fully characterized. The relationship between the formation of cataracts and steroid therapy was evaluated in patients with rheumatic disease. The initiation of steroid therapy in children under 12 years of age (P = 0.041) and i.v. methylprednisone pulse therapy (IVMP) (P = 0.046) are significant risk factors for inducing cataracts. In contrast, the cumulative corticosteroid dose, sex, and daily corticosteroid dose were not associated with cataract formation. Younger children, who need frequent IVMP to treat their rheumatic diseases, should be examined by ophthalmologists frequently to avoid developing amblyopia from cataracts.

The combination of ACTH-cortisone-hydrocortisone with antibiotics in the management of overwhelmingly severe infections

Jahn et al describe the salutary effects of “hormone therapy” in 82 patients with severe infection. Their clinical experience from 1950 to 1953 is summarized and includes presenting patient signs and symptoms, hospital treatment, and eventual outcome. Though not specifically stated, the mortality rate for their patients was 33%, quite similar to mortality rates observed today. More than 50% of their patients were children, many of whom had either Neisseria meningitidis or Haemophilus influenza infections. They write, “There is no question but that the administration of ACTH or cortisone in sufficient amounts to patients with severe infections will result in rapid and striking clinical improvement.” The authors suggest possible mechanisms for these beneficial effects and provide a guideline for steroid use. They specifically mention that all patients with meningococcal meningitis should receive hormonal therapy. Furthermore, they recommend the use of steroid treatment with concomitant antibiotic therapy and adjuvant measures including diet, potassium, testosterone, and estrogen. They make specific recommendations that the duration of antibiotic therapy always be greater than that of hormone therapy, lest cortisone induced “alteration of the inflammatory response permit greater proliferation and dissemination of bacteria.” In sum, strong recommendations are made for the adjuvant use of steroids in all patients with severe infections, especially meningococcal disease. They might be surprised to find that 50 years later the debate continues. Over the past 50 years, recommendations for steroid therapy in patients with severe infection have varied widely. In the 1960s and 1970s, high-dose solumedrol (30 mg/kg/dose) was accepted treatment for patients with septic shock.1 Then in 1987, two randomized trials conducted in adults and two subsequent meta-analyses suggested that steroid treatment for septic shock should be “abandoned.”2-5 More recently, Annane et al demonstrated that steroid therapy for adult patients with relative adrenal insufficiency and septic shock can significantly reduce mortality.6 In 2002, a College of Critical Care Medicine published guideline indicated that children with “refractory septic shock be treated with steroids.”7 Despite this recommendation, no efficacy data regarding steroid treatment for children with septic shock exists. As a result, efforts are underway to conduct a randomized, placebo-controlled trial to examine the value of steroid therapy in children with septic shock. Indeed, the pendulum continues to swing in the saga of steroids and infection. Will we have the definitive answer in the next citation for “50 Years Ago in The Journal”? Download .pdf (.02 MB) Help with pdf files Application 1References can be found online at www.us.elsevierhealth.com/jpeds.

The effects of corticosteroids on behavior in children with nephrotic syndrome.

The objective of this study was to measure the frequency and severity of the behavioral effects of high-dose oral steroid therapy in children with nephrotic syndrome. We conducted a prospective assessment of the behavior of 12 children using a standardized psychological questionnaire at the time of diagnosis and again after 4 weeks of steroid therapy. A group of control children was also assessed. There was a significant increase in the total behavior score ( P=0.03) and specifically in aggressive and poor attention behavior items in the group of nephrotic children compared with the control group. Four of the children with nephrotic syndrome developed abnormal behavior in the clinical range compared with none of the controls. In conclusion, children with nephrotic syndrome treated with high-dose oral steroids are at risk of developing clinically relevant behavioral changes.

Initial bone marrow aspiration in childhood idiopathic thrombocytopenia: decision analysis.

Bone marrow aspiration (BMA) is routinely performed before starting steroid therapy in children with idiopathic thrombocytopenia, primarily to rule out leukemia. A decision tree for the initial management of a child older than age 6 months, presenting with idiopathic thrombocytopenia, without blasts on the peripheral smear was constructed. The three strategies are: 1) initial BMA in all patients; 2) initial BMA only in patients at high risk; and 3) empiric therapy for all patients without initial BMA. High-risk criteria include any of: platelet count >50 x 10(9)/L; hemoglobin <100 g/L (age younger than 12 months) or <110 g/L (age older than 12 months): white blood cell count <5 x 10(9)/L (younger than 6 years) or <4 x 10(9)/L (older than 6 years); or absolute neutrophil count <1.5 x 10(9)/L (younger than 6 years) or <2 x 10(9)/L (older than 6 years). The results are expressed as quality-adjusted life years (QALYs), a measure that estimates the overall life expectancy in years for patients receiving a particular treatment strategy, corrected for the patient's quality of life. The base case results are: 1) BMA all = 69.649 QALYs; 2) high-risk BMA = 69.652 QALYs; and 3) empiric therapy = 69.644 QALYs. These results indicate a three-way toss-up because there is less than a 4-day quality-adjusted difference (0.01) between strategies. This study indicates that the initial BMA does not significantly change the overall QALYs of a child presenting with thrombocytopenia and, consequently, is not mandatory in every patient before starting steroids.