Corticosteroid therapy for nephrotic syndrome in children

Area of Science:

• Pediatric Nephrology
• Clinical Pharmacology
• Systematic Review and Meta-Analysis

Background:

• Nephrotic syndrome in children involves protein leakage, leading to edema and infections.
• Corticosteroids are effective but have adverse effects; optimal treatment duration is unclear.
• Relapse is common, affecting about 70% of children with steroid-responsive nephrotic syndrome (SRNS).

Purpose of the Study:

• To assess the benefits and harms of different corticosteroid regimens for preventing relapse in children with SRNS.
• To clarify optimal corticosteroid doses and durations for treating childhood nephrotic syndrome.

Main Methods:

• Systematic review and meta-analysis of published and unpublished randomized controlled trials (RCTs).
• Included RCTs involved children (3 months–18 years) with initial or subsequent SRNS episodes.
• Compared different corticosteroid durations, doses, and strategies, with outcomes assessed at 6–24 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 linear 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 SRNS episodes should receive at least three months of corticosteroid treatment, with benefits up to seven months.
• A regimen of 4 weeks daily prednisone followed by 6 months alternate-day therapy can reduce relapse by ~40%.
• Deflazacort warrants further investigation for managing frequently relapsing nephrotic syndrome.