ESPN 50th Annual Meeting

ESPN 2017


 
PREDNISOLONE TREATMENT OF RELAPSES OF STEROID SENSITIVE NEPHROTIC SYNDROME MAY RESULT IN LOSS OF BRAIN GREY AND WHITE MATTER VOLUME
Nicholas Webb 1 Helen Sumner 1 Stavros Stivaros 2

1- Royal Manchester Childrens Hospital, Manchester UK
2- University of Manchester
 
Introduction:

Children with steroid sensitive nephrotic syndrome (SSNS) may receive multiple courses of high dose prednisolone for treatment of relapses. Behavioural change is a frequent complication. This study aimed to undertake multi-parametric brain magnetic resonance imaging prior to, during and following completion of high dose prednisolone. Analysis included both anatomical structural assessment as well as cerebral perfusion at all three time points.

Material and methods:

Three boys and two girls aged 7-12y with relapsing SSNS (1-11 relapses) and no prior history of exposure to drugs other than prednisolone underwent brain imaging at the time of relapse, prior to commencement of high dose prednisolone (T0). Imaging was repeated on D21 of high dose prednisolone (T1) and again once prednisolone had been discontinued (T2).  Imaging was performed on a 3 tesla Philips Achieva scanner.  We acquired a whole brain T1 volume 0.9mm3 MPRAGE for anatomical segmentation (FSL, Oxford, UK).  In addition we assessed cerebral perfusion using an arterial spin labelling technique analysed using in house MATLAB routines (www.mathworks.com).

Results:

Only one child failed to complete all scan time-points.  Four children showed a reduction in total brain volume at T1 with recovery to baseline in only one of these children by T2.  Whilst there was loss of both grey and white matter the main driver for this volume loss was grey matter reduction (Figure 1). 

In three children there was a corresponding reduction in cerebral perfusion at T1 which only recovered to baseline in one child.

Conclusions:

High dose prednisolone for treatment of SSNS relapses may result in permanent reduction in both grey and white matter volumes and cerebral perfusion. Further work is ongoing to confirm and further refine these observations.