Korean Journal of Nephrology 1995;14(2):191-197.

Glucocorticoid 투여를 요하는 일차성 신증후군 환아에 대한 Prednisolone 과 Deflazacort(Calcort R) 의 치료 효과 및 골 대사에 미치는 효과 비교

권민중 , 김병길

Abstract

The rate of remission induction with initial steroid therapy in children with minimal change disease is known to be above 90%, of which 40% is frequently relapsing type. In long-term steroid treat- ment, significant side effects occur during the course of therapy such as osteoprosis, growth retardation, obesity, Cushing syndrome and diabetes mellitus. By binding to steroid receptor, deflazacort(Calcort), an oxazoline derivative of prednisolone, exhibit anti- inflammatory and immune suppressive effects, but decreases incidence of osteoporosis by lesser effect on calcium homeostasis and osteoclast activation than prednisolone. Thus the authors investingated 38 patients who need long term steroid therapy because of nephrotic syndrome to see the efficacy and the effect of deflazacort on bone metabolisrn. The 38 patients were randomly divided in two groups with classic drug, prednisolone and new drug, deflazacort. Beside laboratory parameters to ensure the effect of treatment of the nephrotic syndrome, all had measu rements of the bone densitometry, serum levels of parathyroid hormone and osteocalcin at 0 and 3 months of treatrnent. The therapeutic effects on the nephrotic syndrome were not different between the two drugs. The bone loss in the prednisolne-treated group was significantly higher than that of the deflazacort-treated group(Bone mineral content, 0 month vs. 3 month: 0.644±0.133 vs 0.615±0.159 g/cm in prednisolone-treated group, 0.581±0.127 vs 0.599±0.144 g/cm in deflazacort-treated group). There was a more marked fall in osteocalcin in prednisolone-treated group(0 month vs. 3 month: 60.45±47.19 vs 28.69±25.61 ng/ml) compared to deflazacort-treated group(0 month vs. 3 month: 44.20± 33.74 vs 39.33±24.83 ng/rnl). No significant difference was demonstrated between the two groups concerning serum PTH and cortisol. Thus, the detrimental effect of long-term steroid treatment on the bone may not be abolished, but it is significantly reduced by using deflazacort instead of prednisolone.