Prevalence of stunting in patients on treatment for nephrotic syndrome at the Kenyatta National Hospital Renal clinic

Abstract

Background Nephrotic Syndrome occurs most commonly in the age-group of 2-8 years, when the growth rate is at a steady state. Majority of patients (85%) are reported to have Steroid Sensitive Minimal Change Disease, necessitating the use of steroids as the mainstay of treatment. Patients having frequent relapses and requiring repeated courses of steroidsofien develop steroid toxicity, including growth retardation. It is known that daily, supraphysiological doses of glucocorticoids inhibit growth by multiple mechanisms including impaired release of Growth Hormone and decreased activity of Insulin- like Growth Factor-1(IGF-1) in growing bones. However their effect in children with nephrotic syndrome at the KNH Renal Clinic has not been described. Study Objectives: This study aimed to compare the prevalence of stunting in patients on treatment for nephrotic syndrome at the KNH Renal clinic with an age and sex - matched comparative group and as a secondary objective to determine the factors associated with stunting in children with nephrotic syndrome on treatment at the KNH renal clinic. Study design: This was a hospital based cross-sectional study with a matched comparative arm. Results: A total of 124 children were recruited into the study, 62 children with nephrotic syndrome and 62 for the comparative arm. The median age was 11 years with a range of 2 to 19 years. Males were 58.1 % while females 41.9%. Mean age at diagnosis was 7 years. The prevalence of stunting in the nephrotic population was 24.4% with 8% of them being severely stunted while that in the comparative arm was 17.7% with 6% being severely stunted Odds ratio=1.5[(95% Confidence interval, 0.6, 3.5), p= 0.378]. None of the factors studied were found to be associated with stunting. Conclusions: The prevalence of stunting in children with nephrotic syndrome on treatment at the KNH renal clinic was 24.4% with 8% being severely stunted while in the comparative arm, 17.7% were stunted with 6% being severely: stunted. These findings were not statistically significant. Recommendations: Linear growth monitoring for children with nephrotic syndrome should be routinely done. Studies designed to determine the clinical correlates of stunting in children with nephrotic syndrome on treatment should be carried out.