Pulse methylprednisolone therapy in severe idiopathic childhood nephrotic syndrome

The effect of methyl prednisolone therapy (PM) was studied in 18 children with severe idiopathic nephrotic syndrome (NS). Eight patients were defined as "corticosteroid-resistant" because there was no response to treatment after a minimum of 4 weeks of 2 mg/kg/day of prednisone; 10 patients had a corticosteroid-dependent NS with frequent relapses which occurred under a high threshold dose of prednisone (1 mg/kg/day). Each patient received 4-6 pulses of 1 g/1.73 m2 methylprednisolone. Tolerance was generally good. PM therapy permitted a more rapid remission than oral prednisone (average 9 +/- 4 days vs. 22 +/- 9 days). Remission occurred in 5 of the 8 corticosteroid-resistant patients three of these 5 patients developed corticosteroid-dependent NS. For the children with a corticosteroid-dependent nephrotic syndrome, PM therapy did not affect the threshold dose of prednisone.