Behavioral Effects of Corticosteroids in Steroid-sensitive Nephrotic Syndrome

Abstract

Objectives. The objective of this study was to define the frequency and severity of steroid-related behavioral side effects in children with steroid-sensitive idiopathic nephrotic syndrome (SSNS) during treatment for relapse. Study Design. We conducted a prospective, repeated- measures study in which 10 children with SSNS underwent behavioral assessment using the Child Behavior Checklist at baseline and during high dose prednisone therapy for relapse. Results. Of the 10 children, 8 had normal behavior at baseline. Of these 8 children, 5 had Child Behavior Checklist scores above the 95th percentile for anxious/depressive behavior and/or aggressive behavior during relapse. Such scores are in the range normally considered appropriate for referral to a mental health provider. The 2 children who had abnormal behavior at baseline also experienced a worsening of their behavior during relapse. The behavioral changes occurred almost exclusively at prednisone doses of 1 mg/kg every 48 hours or more. Regression analysis showed that prednisone dose was a strong predictor of abnormal behavior, especially increased aggression. Conclusion. Children with SSNS often experience serious problems with anxiety, depression, and increased aggression during high-dose prednisone therapy for relapse.