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Daily corticosteroids reduce infection-associated relapses in frequently relapsing nephrotic syndrome: a randomized

Ashima Gulati1, Aditi Sinha, Vishnubhatla Sreenivas

  • 1Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.

Clinical Journal of the American Society of Nephrology : CJASN
|September 18, 2010
PubMed

Insights

Daily prednisolone during infections significantly reduces nephrotic syndrome relapses in children. This treatment lowers infection-associated and total relapse rates without increasing steroid toxicity, offering a new approach for frequently relapsing nephrotic syndrome.

Area of Science:

  • Pediatric Nephrology
  • Clinical Pharmacology
  • Immunology

Background:

  • Nephrotic syndrome relapses are frequently triggered by minor infections, particularly upper respiratory infections.
  • Children with frequently relapsing nephrotic syndrome (FRNS) experience recurrent episodes, impacting their quality of life and treatment burden.

Purpose of the Study:

  • To evaluate the efficacy of daily prednisolone administration during intercurrent infections in reducing relapse rates in children with FRNS.
  • To assess the impact of this intervention on infection frequency and steroid toxicity.

Main Methods:

  • A randomized controlled trial involving 100 children with idiopathic FRNS was conducted.
  • Patients received either daily prednisolone for 7 days during infections (intervention) or continued their usual alternate-day prednisolone regimen (control).
  • Primary outcome was the rate of infection-associated relapses over a 12-month follow-up period.

Main Results:

  • The intervention group demonstrated significantly lower infection-associated relapse rates (0.7 episodes/patient/year) and total relapse rates (0.9 episodes/patient/year).
  • Daily prednisolone during infections independently reduced relapse frequency by 59% (rate ratio, 0.41).
  • No increase in steroid toxicity was observed in the intervention group.

Conclusions:

  • Daily administration of maintenance prednisolone during intercurrent infections is an effective strategy to significantly reduce relapse rates in children with FRNS.
  • This approach lowers the proportion of children experiencing frequent relapses, improving disease management.
Abstract

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