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Increased maintenance corticosteroids during upper respiratory infection decrease the risk of relapse in nephrotic
1Maternity and Children's Hospital, and King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia. tmattoo@med.wayne.edu
Insights
To reduce relapses in children with idiopathic nephrotic syndrome, increasing daily prednisone during upper respiratory tract infections (URIs) significantly lowered relapse frequency in a prospective study.
Area of Science:
- Pediatrics
- Nephrology
- Immunology
Background:
- Idiopathic nephrotic syndrome (INS) frequently relapses in children.
- Steroid-dependent, relapsing INS requires ongoing management to minimize morbidity.
Purpose of the Study:
- To investigate if a temporary increase in prednisone dosage during upper respiratory tract infections (URIs) can reduce relapse frequency in children with steroid-dependent nephrotic syndrome.
Main Methods:
- A prospective study involving 36 children with steroid-dependent, relapsing INS on alternate-day prednisone maintenance therapy.
- Patients were divided into two groups: Group 1 received daily prednisone for 5 days during URIs, while Group 2 maintained alternate-day prednisone.
- Outcomes were assessed over a 2-year follow-up period.
Main Results:
- Group 1 experienced significantly fewer relapses (mean 2.2 per patient) compared to Group 2 (mean 5.5 per patient) (p = 0.04).
- The intervention of increased prednisone during URIs demonstrated a statistically significant reduction in relapse rates.
Conclusions:
- Temporarily increasing prednisone dosage during URIs is an effective strategy to decrease relapse frequency in children with steroid-dependent nephrotic syndrome on alternate-day therapy.
- This approach offers a potential method to improve long-term outcomes and reduce the burden of frequent relapses in pediatric nephrotic syndrome.
Abstract:
Relapses are common in children with idiopathic nephrotic syndrome, and this prospective study looks into the possibility of decreasing the frequency of relapses in a selected group of such patients. The study includes 36 children with a steroid-dependent, relapsing nephrotic syndrome on a maintenance prednisone therapy of about 0.5 mg/kg every other day. They were prospectively divided into two groups with comparable age and sex distribution and the number of those who had previously received cyclophosphamide therapy. Group 1 patients were advised to take daily prednisone for 5 days, starting at the time of the onset of an upper respiratory tract infection (URI). No such advice was given to those in group 2, and they remained on alternate-day prednisone during URI. At the end of a 2-year follow-up period, the total number of relapses in group 1 was 40 with a mean of 2.2 +/- 0.87 per patient as compared with 99 with a mean of 5.5 +/- 1.33 per patient in group 2 (p = 0.04). We conclude that an increased maintenance prednisone during URI helps decrease significantly the number of relapses in those on alternate-day therapy.