The Effect of High-dose Methylprednisolone on HbA1c, HOMA-IR, Fasting Glucose and Lipid Profile in Child Patients with Lupus Nephritis

Abstract

High-dose methylprednisolone (MP) is widely used to treat aggressive Lupus Nephritis (LN), which may cause metabolic disturbances. Yet, the research on this issue is still controversial. This study aims to analyze the effect of high-dose methylprednisolone on fasting glucose, HbA1c, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), total cholesterol, and LDL in children with lupus nephritis. An observational analytical study with a prospective approach was conducted from June to August 2021. The study sample was lupus nephritis patients at the Pediatric ward of Dr. Soetomo Hospital who met the inclusion and exclusion criteria. The metabolic components (fasting glucose, total cholesterol, HDL, LDL, TG and HOMA-IR) were measured on day 1 before and day-4 after three days of high-dose MP treatment. The comparative test used is the paired t-test and the Mann-Whitney test. Thirty patients were recruited, 16 were girls, with a mean age was 14.15 years old. Most patients (16.7%) were in the fourth cycle of high-dose MP treatment. The mean BMI value in male subjects was 19.79 and that in female subjects was 19.12. We identified significant differences before and after high dose MP in mean fasting glucose (78.17 vs. 110.10, respectively; p=0.001), mean HOMA-IR (3.13 vs. 4.55; p=0.001), mean LDL (132.12 vs. 157.00; p=0.001), mean total cholesterol (202.37 vs. 235.10; p=0.001), mean systole (107.33 vs. 112.33; p=0.005), mean diastole (70.00 vs. 74.50; p=0.002). The comparison of mean not significant result in mean TG values (p>0.05). There was a significant increase in blood sugar levels, HOMA-IR, total cholesterol, and LDL after administration of high-dose methylprednisolone therapy.