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Original

Acute and long-term effects of corticosteroid therapy on bone metabolism in patients with kidney diseases

Ágnes Haris, András Szabó, Éva Lányi, István Mucsi and Kálmán Polner

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Volume 78 (2012) p. 17 - 23

Abstract

Clinical Nephrology, Vol. 78 – No. 1/2012 (17-23)

Acute and long-term effects of corticosteroid therapy on bone metabolism in patients with kidney diseases

Ágnes Haris¹, András Szabó², Éva Lányi³, István Mucsi⁴,⁵,⁶ and Kálmán Polner¹

¹Szent Margit Hospital Nephrology Department, ²Semmelweis University ²^nd Department of Pediatrics, ³Budai Irgalmasrendi Hospital ¹^st Rheumatology Department, ⁴Institute of Behavioral Sciences, Semmelweis University, ⁵Institute of Pathophysiology, Semmelweis University, Budapest, Hungary, and ⁶Division of Nephrology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
Aim: The aim of our study was to examine parameters of bone metabolism during pulse and long-term methylprednisolone (MP) treatment in patients with kidney diseases. Methods: In 13 patients with RPGN, treated with intravenous MP pulses, followed by tapering oral doses, osteocalcin (OC) and β-CrossLaps (β-CL) were measured before treatment, after the 3^rd pulse, then 1 and 3 months later (“acute study”). In a separate set of analyses serum markers of bone metabolism and bone mineral density (BMD) were studied in 40 patients on maintenance MP therapy (“chronic study”). Results: Immediately after the 3^rd MP pulse serum OC decreased to 38 ± 23%, β-CL increased to 200 ± 121% of the baseline (p = 0.002 for OC and p = 0.003 for β-CL, respectively), and the OC/β-CL ratio decreased from 55 ± 35 to 9 ± 7 (p = 0.002). OC remained below and β-CL above baseline even at 3 months post pulse steroid treatment. Patients in the “chronic study” who were on maintenance oral steroid therapy received 13,844 ± 7,454 mg MP over 53 ± 47 months. BMD at the end of follow-up revealed reduced bone mineral density in 72.5% of the participants. Zscores both at the hip and at the lumbar spine were significantly correlated with duration of steroid treatment and also with the cumulative steroid dose. Conclusion: MP pulse causes immediate, profound suppression of osteoblast function, and significant increase of osteoclast activity, suggesting uncoupling of bone formation and resorption. Prolonged high dose steroid treatment causes significant bone loss in patients with chronic kidney disease. Appropriate systematic follow up of bone metabolism, preventive measures and therapy when needed would be important for the bone health of this patient population.Correspondence to:
Ágnes Haris, MD, PhD
Szent Margit Hospital
Nephrology Department
132 Bécsi Street
1032 Budapest, Hungary
Email: [email protected]

Editorial

Kidney health for all: Caring for people, protecting the planet

Raymond Vanholder, Dina Abdellatif, Augusto Cesar Soares Dos Santos Jr., Ricardo Correa-Rotter, Natarajan Gopalakrishnan, Bill Wang, Stefanos Roumeliotis, Alessandro Balducci, Ágnes Haris, Manjusha Yadla, and Li-Li Hsiao

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Volume 106 (2026) p. 1 - 13

Abstract

Clinical Nephrology, Vol. 106 – No. 1/2026 (1-13)

Kidney health for all: Caring for people, protecting the planet

Raymond Vanholder¹#², Dina Abdellatif³, Augusto Cesar Soares Dos Santos Jr.⁴#⁵, Ricardo Correa-Rotter⁶, Natarajan Gopalakrishnan⁷, Bill Wang⁸, Stefanos Roumeliotis⁹, Alessandro Balducci¹⁰, Ágnes Haris¹¹, Manjusha Yadla¹², and Li-Li Hsiao¹³

¹Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, ²European Kidney Health Alliance, Brussels, Belgium, ³Department of Nephrology, Cairo University Hospital, Cairo, Egypt, ⁴Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, ⁵Hospital das Clinicas, Ebserh, Universidade Federal de Minas Gerais, Minas Gerais, Brazil, ⁶Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, ⁷Transplant Authority of Tamil Nadu, Chennai, India, ⁸Hong Kong Kidney Foundation, Hong Kong, SAR, China, ⁹²nd Department of Nephrology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece, ¹⁰Italian Kidney Foundation Italy, Rome, Italy, ¹¹Department of Internal Medicine and Nephrology, Péterfy Hospital, Budapest, Hungary, ¹²Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana, India; and ¹³Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
The current kidney care model – focused on late-stage disease and in-center hemodialysis – is unsustainable, because of costs, environmental burden, poor outcomes, and reduced quality of life. The 78th World Health Assembly’s recognition of kidney disease as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, “Kidney Health for All: Caring for People, Protecting the Planet”, calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, environment and society. Dialysis itself must become more eco-friendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly for elderly and frail patients, if the quality-of-life benefits outweigh the perspectives offered by dialysis. Achieving this shift requires coordinated action across all stakeholders; education and engagement of the public, policy makers and health professionals to raise awareness about the threat of kidney disease; and an urgent move toward patient-centered care.Correspondence to:
Dr. Stefanos Roumeliotis, MD, PhD, FERA
Nephrologist, Fellow of the World Kidney Day Joint Steering Committee
2nd Department of Nephrology
AHEPA Hospital, Medical School
Aristotle University of Thessaloniki
1 St. Kyriakidi street
54636 Thessaloniki, Greece
Email: [email protected]

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