title: Spinal epidural lipomatosis in children with renal diseases receiving steroid therapy.
abstract: Spinal epidural lipomatosis (SEL) in patients on steroid therapy may be explained by two hypotheses: (1) steroids induce SEL and (2) steroids cause the growth of a pre-existing SEL, especially in obese children. Steroid-induced SEL (SSEL) is rarely described in children, with only six cases reported elsewhere. However, we have already reported four nephrotic children with SSEL, including one child in another hospital, in addition to the six cases. We investigated the frequency of SSEL in 125 children with renal diseases treated with glucocorticoids in a single hospital over 16 years, and examined the risk factors in 62 patients with SSEL reported in the literature. When patients complained of symptoms at the early stage of SSEL, i.e., back pain or numbness, and patients were obese, we performed spinal magnetic resonance imaging (MRI). SSEL was detected in 5 of 125 children (4.0%). Of the 5 patients with SSEL, 3 had vertebral compression fractures, and all 5 patients were on methylprednisolone pulse therapy. Our study suggests that many more patients can be detected at the early stage of SSEL by performing spinal MRI for patients with early symptoms, obesity, and those who have received methylprednisolone pulse therapy.
authors.affiliation: Department of Pediatrics, Dokkyo University School of Medicine, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi 321-0293, Japan. k-kano@dokkyomed.ac.jp
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kano
authors.forename: Keisho
authors.initials: K
authors.lastname: Kyo
authors.forename: Sachio
authors.initials: S
authors.lastname: Ito
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Nishikura
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Ando
authors.forename: Yumi
authors.initials: Y
authors.lastname: Yamada
authors.forename: Osamu
authors.initials: O
authors.lastname: Arisaka
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004824:Epidural Space; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy*; D008068:Lipomatosis / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects*; D009765:Obesity / Q000150:complications; D020551:Pulse Therapy, Drug; D013122:Spinal Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone