Back
The management of kidney disease is a challenge. Steroid is often an integral part of many chronic kidney diseases (CKD) treatment regimens notably glomerulonephritis (GN). Steroids are either used as monotherapy or in combination with other medications. High doses of steroids may be prescribed in such cases with sparsely reported adverse effects. This study was therefore aimed at highlighting the complications of steroid therapy in patients with GN.
This single centre retrospective study was done at the University of Nigeria Teaching Hospital (UNTH), Enugu State, Nigeria which is a major nephrology referral centre in south-eastern Nigeria. Medical records of adult CKD patients with diagnosis of GN seen between September 2018 and September 2023 at the UNTH nephrology outpatient clinics were assessed. Diagnosis of GN was based on kidney biopsy, supporting laboratory results including relevant serology as well as clinical signs and symptoms in keeping with GN in the absence of other causes of CKD including diabetes mellitus (DM), hypertension and obstructive nephropathies. Steroid prescribed was prednisolone at a dose of 1mg/kg/day with maximum of 60mg/day. Only new onset signs and symptoms noted after steroid therapy initiation were analyzed. All steroid complications developed within 3 months of steroid therapy initiation. Iatrogenic DM was defined by ≥2 blood glucose levels ≥ 7.0 mmol/L (126 mg/dL) and/or ≥ 11.1 mmol/L (200 mg/dL)in fasting and random samples respectively associated with steroid use without prior DM history. Persistent blood pressure ≥140/90 following steroid initiation in previously normotensive patients was diagnosed as steroid induced hypertension.
Medical records of 656 (371 (56.6%) males, 285 (43.4%) females) CKD patients were assessed. However, 384 (58.5%) of them had GN as shown in table 1.
One hundred and forty three patients (primary GN: 118 (82.5%), SLE: 23(16.1%), other CTDs: 2(1.4%) received steroid therapy. The various steroid use complications are shown in fig.1 below. Conclusions
Despite being an integral part of many therapies for management of GN,steroid use is fraught with complications. These complications should be looked out for, detected early and appropriate management instituted including steroid withdrawal or tapering to prevent further complications.