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Short versus long initial prednisone treatment in steroid-sensitive nephrotic syndrome in children
1Department of Nephrology, Child Health Centre, Warsaw, Poland.
Insights
Longer prednisone treatment for steroid-responsive nephrotic syndrome in children significantly reduces relapse rates. Six months of treatment resulted in more children remaining relapse-free over two years compared to shorter durations.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacology
Background:
- Steroid-responsive nephrotic syndrome (SRNS) is a common kidney disease in children.
- Relapse prevention is a key challenge in managing SRNS.
Purpose of the Study:
- To compare the efficacy of different durations of prednisone treatment in preventing relapses of SRNS in children.
- To determine the optimal treatment duration for minimizing relapses and improving long-term outcomes.
Main Methods:
- A randomized study involving 184 children with their first episode of SRNS.
- Three treatment protocols with varying prednisone tapering schedules over 2, 3, and 6 months.
- A 2-year follow-up period after prednisone withdrawal to assess relapse rates.
Main Results:
- The 6-month treatment protocol showed the best outcomes, with 50% of children relapse-free at 2 years and an average of 0.49 relapses/patient/year.
- Shorter treatment durations (2 and 3 months) resulted in significantly higher relapse rates (20.6%–27.3% relapse-free at 2 years) and more relapses per patient per year (0.77–0.79).
Conclusions:
- Extended prednisone treatment for 6 months is more effective in preventing relapses of SRNS in children than shorter durations.
- Optimizing the duration of corticosteroid therapy can improve long-term disease control in pediatric nephrotic syndrome.
Abstract:
A total of 184 children aged, 13 months to 11 years, suffering from their first attack of steroid-responsive nephrotic syndrome were included in a randomized study. They were treated according to three treatment protocols. All children received 1-2 mg of prednisone/kg body weight/day (up to 80 mg daily) for 4 weeks, and thereafter 1 mg/kg body weight/48 h for the next 4 weeks. Treatment was discontinued at this point in 44 children (protocol A); in 68 (protocol B) the dose was reduced by 25% each week, tapering off to 0 at the end of the third month, while in 72 children (protocol C), after the first 2 months of initial treatment the dose was reduced by 25% each month and tapered off to 0 by the end of the sixth month. All patients completed a 2-year follow-up period after withdrawal of prednisone. Treatment results were expressed as: percentage of children relapse-free within the first 6 months and 2 years after withdrawal of treatment, and average number of relapses per patient per year. The best results were obtained in children who had been treated for 6 months; 65.3% of them remained relapse-free within the first 6 months and 50% over the entire 2-year follow-up period; the number of relapses per patient per year in this group was 0.49. The respective values for children treated 2 and 3 months were: 36.4% and 32.4% for the 6-month period; 27.3% and 20.6% for the 2-year period; the numbers of relapses per patient per year were 0.79 and 0.77, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)