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Corticosteroid therapy for nephrotic syndrome in children
E M Hodson1, J F Knight, N S Willis
1Centre for Kidney Research, Royal Alexandra Hospital for Children, PO Box 3515, Parramatta, New South Wales, Australia, 2124. Elisah@nch.edu.au
The Cochrane Database of Systematic Reviews
|October 18, 2000
Summary
Longer corticosteroid treatment for childhood nephrotic syndrome (SRNS) significantly reduces relapse risk without increasing adverse events. Extended treatment durations, up to seven months, offer greater benefits for children with SRNS.
Area of Science:
- Pediatric Nephrology
- Pharmacology
- Clinical Trials
Background:
- Nephrotic syndrome causes protein leakage in children, leading to edema and increased infection risk.
- Corticosteroids are effective but have adverse effects; optimal treatment durations remain unclear.
- This review assesses corticosteroid benefits and harms in childhood nephrotic syndrome.
Purpose of the Study:
- To determine the benefits and harms of different corticosteroid regimens in preventing relapse in children with steroid-responsive nephrotic syndrome (SRNS).
Main Methods:
- Systematic review and meta-analysis of published and unpublished randomized controlled trials.
- Included trials involved children (3 months–18 years) with initial or subsequent SRNS episodes.
- Compared different corticosteroid doses, durations, and strategies with outcomes at ≥6 months.
Main Results:
- Longer prednisone treatment (≥3 months vs. 2 months) significantly reduced relapse risk (RR 0.73) at 12–24 months without increased adverse events.
- An inverse relationship existed between treatment duration and relapse risk.
- Deflazacort was more effective than prednisone in maintaining remission for frequently relapsing cases (RR 0.44).
Conclusions:
- Children with initial nephrotic syndrome episodes should receive at least three months of corticosteroid treatment, with benefits up to seven months.
- Extended treatment can reduce relapse rates by approximately 40%.
- Deflazacort warrants further investigation for frequently relapsing nephrotic syndrome.