Hepatic Steatosis Complicating Pediatric Idiopathic Nephrotic Syndrome During Systemic Corticosteroid Therapy: A Case Report.

Hepatic steatosis is a rare complication of pediatric idiopathic nephrotic syndrome, and its clinical course has infrequently been described. A 22-month-old boy presented with generalized edema, oliguria, and massive proteinuria and was diagnosed with idiopathic nephrotic syndrome complicated by urinary tract infection. Following infection control, prednisolone was initiated according to the International Study of Kidney Disease in Children regimen, and complete remission was achieved by day 17. Serum aminotransferase levels increased on day 19, followed by progressive hepatomegaly. Abdominal ultrasonography revealed mild hepatic steatosis (score 1) on day 28, which progressed to severe steatosis (score 3) by day 45 despite improving serum lipid and aminotransferase levels. Noncontrast computed tomography on day 37 revealed hepatomegaly with decreased hepatic attenuation. A workup for secondary causes of steatosis was unremarkable. Following prednisolone tapering and discontinuation, hepatomegaly resolved by day 64, and hepatic steatosis gradually improved, with normalization confirmed on ultrasonography on day 246. The nephrotic syndrome has not recurred for more than five years after corticosteroid withdrawal. Hepatic steatosis may develop during corticosteroid treatment for pediatric idiopathic nephrotic syndrome, potentially owing to nephrotic hyperlipidemia and/or corticosteroid exposure. Ultrasonographic recovery may lag behind clinical remission and may take several months.