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Published on: May 26, 2023
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Corticosteroid therapy for nephrotic syndrome in children
Deirdre Hahn1, Susan M Samuel2, Narelle S Willis3,4
1Department of Nephrology, The Children's Hospital at Westmead, Westmead, Australia.
The Cochrane Database of Systematic Reviews
|August 22, 2024
Summary
For children with steroid-sensitive nephrotic syndrome (SSNS), extending prednisone therapy beyond two to three months offers no additional benefit. Shorter durations and lower doses are as effective and may reduce adverse events.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Nephrotic syndrome causes protein leakage, leading to low blood protein and edema.
- While corticosteroids are effective, 80% of children experience relapses, and long-term use has significant adverse effects.
- This review updates evidence on corticosteroid regimens for children with steroid-sensitive nephrotic syndrome (SSNS).
Approach:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) in children (1-18 years) with SSNS.
- Searched Cochrane Kidney and Transplant Register, CENTRAL, MEDLINE, EMBASE, and clinical trial registries.
- Assessed benefits and harms of different corticosteroid durations, doses, and strategies.
Key Points:
- No significant difference in relapse rates or adverse events when extending prednisone therapy beyond 2-3 months for initial SSNS episodes.
- Lower induction doses or shorter durations showed no efficacy difference in children with relapsing SSNS.
- Recent large studies found no benefit of daily prednisone during viral infections to prevent relapse, contradicting some earlier small studies.
Conclusions:
- Prolonging prednisone therapy beyond 2-3 months for the first SSNS episode provides no added benefit.
- Current evidence suggests shorter durations and lower doses may be effective for relapsing SSNS.
- Further large, well-designed studies are needed to confirm findings on prednisone strategies during infections.
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