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Abstract: FR-PO648

Incidence and Risk Factors for Obesity and Short Stature in Childhood Nephrotic Syndrome: A Prospective Cohort Study

Session Information

  • Pediatric Nephrology - II
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • Robinson, Cal, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Aman, Nowrin F., The Hospital for Sick Children, Toronto, Ontario, Canada
  • Chanchlani, Rahul, McMaster Children's Hospital, Hamilton, Ontario, Canada
  • Dhillon, Vaneet, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Licht, Christoph, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Noone, Damien Gerard, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Pearl, Rachel Jane, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Radhakrishnan, Seetha, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Teoh, Chia Wei, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Parekh, Rulan S., The Hospital for Sick Children, Toronto, Ontario, Canada
Background

Children with nephrotic syndrome are at risk of obesity and short stature from repeated steroid treatment. The incidence, timing, and risk factors for these outcomes remain uncertain.

Methods

We evaluated longitudinal growth and obesity in children (1-18yr) enrolled in Insight into Nephrotic Syndrome: Investigating Genes, Health, and Therapeutics (INSIGHT). We included nephrotic syndrome cases diagnosed from 1996-2019 in Greater Toronto. Growth parameters were measured at annual clinic visits. Primary outcomes were de novo obesity (body mass index (BMI) Z-score ≥+2) and short stature (height Z-score ≤-2). We calculated hazard ratios (HR) using Cox proportional hazards models.

Results

We included 531 children with nephrotic syndrome (24% frequently relapsing (FRNS) by 1-year). At their initial clinic visit (within 1-year of diagnosis), 23.5% of cases were obese, 51.8% were overweight (BMI Z-score ≥+1), and 4.9% had short stature. At the last clinic visit, the prevalence of obesity had decreased (17.3%) and short stature was unchanged (3.8%). During median 4.2-year follow-up, 69 (17.7%) children developed obesity and 16 (3.3%) developed short stature, among those without obesity or short stature initially. Total relapse count was a significant predictor for de novo obesity (adjusted HR 1.03, 95%CI 1.01-1.06, p=0.01) and short stature (unadjusted HR 1.06, 95%CI 1.02-1.10, p=0.01). Children with >6 and >12 total relapses were more likely to develop obesity and short stature, respectively.

Conclusion

Obesity is common among children with nephrotic syndrome early after diagnosis, but prevalence decreases over time. Effective relapse prevention may reduce steroid exposure and the risks of de novo obesity or short stature.

Obesity and height outcomes, by FRNS classification within 1-year of diagnosis
OutcomeOverall (n=531)Non FRNS (n=404)FRNS (n=127)
Prevalent obesity at initial clinic visit, n (%)125/531 (23.5)89/404 (22.0)36/127 (28.4)
De novo obesity during follow-up, n (%)69/390 (17.7)46/302 (15.2)23/88 (26.1)
Prevalent obesity at last clinic visit, n (%)91/526 (17.3)65/399 (16.3)26/127 (20.5)
Prevalent short stature at initial clinic visit, n (%)26/531 (4.9)21/404 (5.2)5/127 (3.9)
De novo short stature during follow-up, n (%)16/488 (3.3)8/369 (2.2)8/119 (6.7)
Prevalent short stature at last clinic visit, n (%)20/525 (3.8)13/398 (3.3)7/127 (5.5)
Change in BMI Z-score during follow-up, mean (SD)-0.52 (1.23)-0.48 (1.19)-0.65 (1.34)
Change in height Z-score during follow-up, mean (SD)+0.19 (0.84)+0.22 (0.79)+0.09 (0.97)

Funding

  • Government Support – Non-U.S.