Nefrotik Sendromlu Çocuklarda Tedavi Yan Etkilerinin Değerlendirilmesi

Öz

Amaç: Ülkemizde nefrotik sendrom NS tedavisi sırasında görülen yan etkilerin sıklığını yansıtan veriler yetersizdir. Bu çalışmada, kliniğimizde NS nedeniyle izlenen hastalarda ortaya çıkan tedavi yan etkilerinin değerlendirilmesi amaçlandı.Gereç ve Yöntem: İstanbul Üniversitesi İstanbul Tıp Fakültesi Çocuk Nefrolojisi Bilim Dalı Polikliniğine 1986-2010 yılları arasında başvuran ve NS tanısı ile izleme alınan toplam 206 hastanın 126 erkek, 80 kız poliklinik dosyaları incelenerek verileri geriye dönük olarak değerlendirildi.Bulgular: Çalışma grubuna alınan toplam 206 hastanın 126 erkek; 80 kız başvuru sırasındaki yaş ortalaması 3,8±2,8 yıl 0.2-13.8 yıl idi. İzlemde herhangi bir ilaca karşı hastaların 171’inde %83 en az bir yan etki oluştu. Steroid tedavisinde görülen yan etkiler sırasıyla cushingoid görünüm gelişmesi %52 , hipertansiyon %23.4 , büyüme geriliği %17 , katarakt %6.8 ve osteoporoz %6.8 idi. Büyüme geriliği, osteoporoz, katarakt ve hipertansiyon saptanan hastalarda saptanmayan hastalara göre steroid tedavi süresi ve toplam steroid dozu anlamlı olarak yüksekti p

Anahtar Kelimeler

• Nefrotik sendrom,steroid tedavisi,steroide bağlı yan etkiler

Evaluation of the Advers Effects of the Treatment of Nephrotic Syndrome in Children

Öz

Objective: The data reflecting adverse effects seen during the treatment of nephrotic syndrome NS in Turkey are limited. In this study, we aimed to evaluate the side effects of treatment of NS patients observed at our clinic.Material and Method: We retrospectively reviewed the data of 206 patients with NS 126 male; 80 female followed up at the Pediatric Nephrology outpatient clinic of the Istanbul University Istanbul Medical Faculty between 1986-2010.Results: Mean age of 206 126 male, 80 female patients at the time of admission was 3.8±2.8 years range: 0.2-13.8 . During follow-up, 171 patients 83% experienced at least one side effect due to any of the drugs. The most frequent side effects of steroid treatment in order of decreasing frequency were cushingoid appearance 52% , hypertension 23.4% , growth retardation 17% , cataract 6.8% and osteoporosis 6.8% . Total duration of steroid use and steriod dose were higher in the patients who suffered from growth retardation, osteoporosis, cataract, hypertension than in those who did not suffer these side effects p

Anahtar Kelimeler

• Nephrotic syndrome,steroid therapy,steroidinduced side effect

Kaynakça

1. Eddy AA, Symons JM. Nephrotic syndrome in child- hood. Lancet 2003;362:629-39.
2. https://doi.org/10.1016/S0140-6736(03)14184-0
3. Niaudet P, Olivia B. Idiopathic nephrotic syndrome in children: Clinical aspects. In: Pediatric Nephrology. Avner ED, Harmon WE, Niaudet P, Yoshikawa N (eds). Springer-Velag Berlin Heidelberg, 2009;667-702.
4. Neyzi O, Furman A, Bundak R, gunoz H, Darendeliler F, Bas F. Growth references for Turkish children aged 6 to 18 years. Acta Pediatrica 2006;95: 1635-41.
5. https://doi.org/10.1080/08035250600652013
6. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication No. 04-5230 August 2004
7. gipson DS, Massengill SF et al. Management of childhood onset nephrotic syndrome. Pediatrics 2009;124:747.
8. https://doi.org/10.1542/peds.2008-1559

9. Keenan g. Management of complications of glucocor- ticoid therapy. Clin Chest Med 1997;18:507-20.
10. https://doi.org/10.1016/S0272-5231(05)70398-1
11. mendoza Sa, Tune Bm. Treatment of childhood nephrotic syndrome. J Am Soc Nephrol 1992;3:889- 94.
12. Donatti Tl, Koch VH, Fujimura MD, Okay Y. Growth in steroid responsive nephrotic syndrome: a study of 85 pediatric patients. Pediatr Nephrol 2003;18:789-95.
13. https://doi.org/10.1007/s00467-003-1142-0
14. Emma F, Sesto A, Rizzoni g. Long-term linear growth of children with severe steroid-responsive nephrotic syndrome. Pediatr Nephrol 2003;18:783-8.
15. https://doi.org/10.1007/s00467-003-1176-3
16. kalman S. Çocukluk çağında steroide dirençli nefrotik sendromda önemli bir neden olan fokal segmental glo- merülosklerozda tedavi yaklaşımları. GMJ 2004;46(2):183-8.
17. Rees l, greene SA, Adlard P, Jones J, Haycock gB, Rigden SPA et al. Growth and endocrine function in steroid sensitive nephrotic syndrome. Archives of Disease in Childhood 1988;63:484-90.
18. https://doi.org/10.1136/adc.63.5.484
19. Schäcke H, Döcke WD, Asadullah K. Mechanisms involved in the side effects of glucocorticoids. Pharmacology and Therapeutics 2002;96(1):23-43.
20. https://doi.org/10.1016/S0163-7258(02)00297-8
21. gheissari A, Attarzadeh H, Sharif H, Pourhossein M, Merrikhi A. Steroid dependent and independent ocular findings in Iranian children with nephrotic syndrome. Int J Prev Med 2011;2(4):264-8.
22. Fakhouri F, Bocquet N, Taupin P, Presne C, gagnadoux MF, landais P, et al. Steroid-sensitive nephrotic syndrome: from childhood to adulthood. Am J Kidney Dis 2003;41(3): 550-7.
23. https://doi.org/10.1053/ajkd.2003.50116
24. Arslan Ş, Reyhan Çeliker R, Karabudak R. Cumulative corticosteroid doses and osteoporosis in patients with multiple sclerosis. Turk J Rheumatol 2010;25:191-5.
25. https://doi.org/10.5152/tjr.2010.27
26. Brocklebank JT, Harcourt RB, Meadow SR. Corticosteroid-induced cataracts in idiopathic nephro- tic syndrome. Arch Dis Child 1982;57:30.
27. Ng JS, Wong W, law RW, et al. Ocular complications of pediatric patients with nephrotic syndrome. Clin Exp Ophthalmol 2001;29:239.
28. https://doi.org/10.1046/j.1442-9071.2001.00426.x
29. Chen S, Wu C, Tsai IJ, Tsau YK. Treatment course of steroid-dependent nephrotic syndrome: Emphasized on treatment effect. Nephrology 2010;15:336-9.
30. https://doi.org/10.1111/j.1440-1797.2009.01190.x
31. Azib S, Macher MA, Kwon T, Dechartres A, Alberti C, Chantal loirat C, et al. Cyclophosphamide in steroid-dependent nephrotic syndrome. Pediatr Nephrol 2011;26:927-32.
32. https://doi.org/10.1007/s00467-011-1830-0
33. Hodson EM, Willis NS, Craig JC. Non-corticosteroid treatment for nephrotic syndrome in children. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No: CD002290.
34. https://doi.org/10.1002/14651858.CD002290.pub3
35. Kari JA, Halawani M. Treatment of steroid resistant nephrotic syndrome in children. Saudi J Kidney Dis Transpl 2010;21:484-7.
36. Hirano D, Nishizaki N, Kanai H, Hara S, Ohtomo Y, umino d, et al. Long-term outcome of children treated with the ISKDC regimen for the first episode of INS. Nihon Jinzo Gakkai Shi 2010;52(8):1029-36.
37. Kher KK. Nephrotic syndrome. In: Clinical Pediatric Nephrology, Kher KK Eds. 2nd Edition, Oxon: Informa Healthcare, 2007:155-194.