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Treatment of idiopathic nephrotic syndrome with two steroid dosing regimens - one-year observational study
Małgorzata Pańczyk-Tomaszewska1, Piotr Skrzypczyk1, Kacper Mroczkowski2
1Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland.
Insights
Body surface area (BSA)-based prednisone dosing for pediatric idiopathic nephrotic syndrome (INS) reduces steroid exposure and relapse risk compared to weight-based dosing. This approach increases steroid-free intervals in the first year of treatment.
Area of Science:
- Pediatric Nephrology
- Pharmacology
- Clinical Therapeutics
Background:
- Idiopathic nephrotic syndrome (INS) is a common kidney disorder in children.
- Prednisone dosing strategies significantly impact treatment outcomes and steroid exposure.
- Optimizing prednisone regimens is crucial for managing pediatric INS effectively.
Purpose of the Study:
- To compare the clinical outcomes of weight-based versus body surface area (BSA)-based prednisone dosing in children with INS during their first year of disease.
- To evaluate differences in relapse rates, steroid exposure, and adverse effects between the two dosing regimens.
Main Methods:
- A comparative study involving two groups of children with INS (n=40).
- One group received weight-based prednisone dosing; the other received BSA-based dosing.
- Clinical parameters, anthropometry, relapse frequency, total prednisone dose, and adverse events were monitored over the first year.
Main Results:
- The weight-based regimen resulted in significantly higher total annual prednisone doses (259.06 mg/kg/year) compared to the BSA-based regimen (185.83 mg/kg/year).
- More patients experienced relapses in the weight-based group (19/20) versus the BSA-based group (13/20), although the number of relapses per patient was similar.
- No significant differences were observed in height, weight, BMI Z-scores, or steroid-related adverse events, except for a similar incidence of arterial hypertension.
Conclusions:
- BSA-based prednisone dosing in pediatric INS is associated with reduced overall steroid exposure and a lower risk of relapse in the first year.
- This regimen also increases the duration of steroid-free periods compared to weight-based dosing.
- BSA-based dosing represents a potentially more favorable strategy for managing pediatric INS.
Introduction:
The aim of the study was to compare the first year of disease in children with idiopathic nephrotic syndrome (INS) treated according to two prednisone dosing regimens: a weight-based schedule (2 mg/kg/24 h in the 1st month, 2 mg/kg/48 h in the 2nd month, with dose tapering during the following 4 months), and a body surface area (BSA)-based schedule (60 mg/m2/24 h in the 1st month, 40 mg/m2/48 h in the 2nd month, with dose tapering during the following 4 months).
Material And Methods:
In 2 groups of children treated with weight- and BSA-based regimens (20 patients, 3.13 ±1.01 years, treated in 2010-2013 and 20 patients, 5.13 ±2.86 years, treated in 2014-2016) clinical and anthropometrical parameters, number of INS relapses, total prednisone dose (mg/kg/year), and steroid adverse effects were compared during the first year of disease.
Results:
Children treated with the weight-based steroid regimen received a higher total annual prednisone dose (259.06 ±79.54 vs. 185.83 ±72.67 mg/kg/24 h, p = 0.004) and had a shorter (though not significantly) period without prednisone (38.25 ±55.83 vs. 75.90 ±73.06 days, p = 0.062) compared to patients treated with the BSA-based regimen. There was no difference in number of relapses between groups (2.20 ±1.64 vs. 1.60 ±1.67, p = 0.190) but more patients relapsed in the weight-based group (19/20 vs. 13/20, p = 0.044). No differences in Z-score values of height, weight, and body mass index (BMI) were observed. No steroid-related adverse events were noted except for arterial hypertension (4/20 vs. 5/20 patients, p = 1.000).
Conclusions:
The BSA-based regimen of prednisone dosing in children with INS reduces exposure to steroids and risk of relapse, as well as increases days off steroids in the first year compared to the weight-based regimen with a high second-month dose.
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