Source:

Raja
K
,
Parikh
A
,
Webb
H
,
Hothi
D
.
Use of a low-dose prednisolone regimen to treat a relapse of steroid-sensitive nephrotic syndrome in children
.
Pediatr Nephrol
.
2017
;
32
(
1
):
99
105
; doi:
https://doi.org/10.1007/s00467-016-3458-6

Researchers from Great Ormond Street Hospital in London conducted 2 studies to evaluate the effectiveness of low-dose prednisone in treating relapse in children with steroid-sensitive nephrotic syndrome (SSNS). The retrospective analysis included healthy children with SSNS who started taking 1 mg/kg prednisone daily for ≥7 days to treat relapsing SSNS between January 2012 and July 2013 at 2 sites in London. The current treatment in the UK for children with relapsing SSNS is typically 2 mg/kg/d until complete remission for at least 3 days. For the study, a relapse was defined as significant proteinuria according to a dipstick test for at least 3 consecutive days, and remission was defined as 0 or trace proteinuria for at least 3 days. The main outcome was the proportion of patients achieving remission on the low-dose regimen; the relapse rate in the 6 months prior to and the 6 months after the index relapse in each child was compared by using a paired t test. The second study was a random selection of the patients in the initial study who had been treated with both standard-dose and low-dose prednisone for different relapses. In July 2015, parents of the selected study patients completed separate PedsQL 4.0 questionnaires to assess their child’s quality of life (QOL) in 4 separate domains during relapses treated with the standard- or low-dose regimens.

A total of 50 children aged 3–17 years (mean, 9.1 years) were included in the primary investigation. In all, 87 relapses occurred; remissions were achieved by using the low-dose regimen in 61 (70%). The mean number of relapses in the 6 months prior to the index relapse in study patients was 1.01, compared to a mean of 0.86 relapse per patient in the subsequent 6 months (P = .30). Parents of 15 study children subsequently completed PedsQL 4.0 questionnaires. For each of the 4 domains, scores were significantly higher (indicating higher QOL) when parents rated their child’s QOL during low-dose treatment compared to standard-dose treatment of relapses.

The authors conclude that a low-dose prednisone regimen helped to achieve remission in 70% of relapses in children with SSNS without compromising the relapse rate and was associated with higher QOL when compared to standard-dose treatment.

Dr. Singer has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Minimal-change nephrotic syndrome, one of the most commonly encountered glomerular diseases of childhood, is defined by its overall sensitivity to corticosteroids. Approximately 80% of patients with minimal-change nephrotic syndrome respond to steroids, and a 2–3-month course is standardly prescribed at initial presentation, with shorter courses used for relapses. While effective at achieving remission, prolonged steroid courses result in...

You do not currently have access to this content.