Daily single-dose and daily reduced-dose prednisone therapy for children with the nephrotic syndrome

Most current reference sources recommend that initial therapy for minimal lesion nephrotic syndrome consist of prednisone, 60 mg/m2 per 24 hours or 2 mg/kg per 24 hours, given in divided doses, and that this regimen be repeated for each relapse. The need for divided-dose daily-administered prednisone is predicated on anecdotal observations that single-dose daily administration is not effective. Because single-dose daily-administered and reduced-dose daily-administered prednisone has been used to treat this condition for several years, experience with these regimens in nephrotic children was analyzed. Forty-one patients were studied, including 22 treated from the onset of their disease. Of these 22, 17 (77%) responded to single-dose daily-administered prednisone (2 mg/kg); after subsequent biospy, each of the nonresponders proved to have lesions other than minimal change disease. The mean response time with single-dose daily-administered prednisone (9.6 days for treatment of the initial onset of nephrotic syndrome and 11.1 days for treatment of relapses) was comparable to that previously reported with divided-dose regimens. In 14 patients with frequent relapses, a single reduced-dose daily-administered dose of prednisone (0.2 to 1.5 mg/kg/d) successfully induced remissions in 55 of 63 relapse episodes. It is concluded that a single morning dose of prednisone effectively induces remission in children with minimal lesion nephrotic syndrome. Among selected patients with frequent relapses, additional steroid sparing may be achieved by the use of this regimen with reduced doses during treatment of relapses.