Long versus standard initial steroid therapy for children with the nephrotic syndromeA report from the Southwest Pediatric Nephrology Study Group

• Published in: Pediatric nephrology (Berlin, West) West), 2003-04, Vol.18 (4), p.342
• Main Authors: Lande, Marc B, Gullion, Christina, Hogg, Ronald J, Gauthier, Bernard, Shah, Binod, Leonard, Mary B, Bonilla-Felix, Melvin, Nash, Martin, Roy, 3rd, Shane, Strife, C Frederic, Arbus, Gerald
• Format: Article
• Language: English
• Subjects: Adolescent; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - adverse effects; Anti-Inflammatory Agents - therapeutic use; Blood Pressure - drug effects; Canada; Child; Child, Preschool; Dose-Response Relationship, Drug; Female; Glomerular Filtration Rate - drug effects; Humans; Infant; Male; Nephrotic Syndrome - drug therapy; Nephrotic Syndrome - physiopathology; Prednisone - administration & dosage; Prednisone - adverse effects; Prednisone - therapeutic use; Retrospective Studies; Risk Assessment; Steroids - adverse effects; Steroids - therapeutic use; Time Factors; United States
• ISSN: 0931-041X

A retrospective cohort study was conducted by the Southwest Pediatric Nephrology Study Group (SPNSG) to address whether a longer initial course of corticosteroids in patients with idiopathic nephrotic syndrome (INS) provides superior protection against relapse without increased adverse effects. In order to be included in the evaluation, patients with INS must have responded to an initial steroid course, either standard or long regimen as defined here, and completed at least 1 year of follow-up. The standard regimen consisted of prednisone 2.0+/-0.3 mg/kg per day or 60+/-10 mg/m(2) per day for 28+/-4 days, followed by alternate-day prednisone for 4-12 weeks. The long regimen consisted of daily prednisone 2.0+/-0.3 mg/kg per day or 60+/-10 mg/m(2) per day for 42+/-6 days, followed by alternate-day prednisone for 6-14 weeks. The primary outcome measure was relapse of NS within 12 months of discontinuing the initial course of prednisone. There were 151 children who met the criteria for the study; 82 received the standard regimen and 69 the long regimen. The two groups did not differ in age, race, blood pressure, serum albumin, or serum cholesterol prior to the initial steroid course. The cumulative prednisone dose was 49% higher in the long regimen group than in the standard regimen group. Relapse within 12 months was reported in 72.5% of patients who received the long regimen versus 84.1% of those who received the standard regimen. The odds ratio for relapse within 12 months was 0.496 (95% confidence interval 0.22, 1.088), long versus standard regimen. This did not reach statistical significance ( chi(2)=3.058, P=0.08). The odds ratio of experiencing at least one side effect was 3.76, long relative to standard regimen ( n=133, P