Risk of relapse in steroid-sensitive nephrotic syndrome: effect of stage of post-prednisone adrenocortical suppression.
Glucocorticoid therapy has been effective in inducing remission in the majority of children with primary nephrotic syndrome. However, glucocorticoid-induced adrenocortical suppression is associated with early relapse, whereas normal adrenocortical function seems to delay the subsequent relapse. We analyzed 201 episodes of prednisone treatment in 47 children with steroid-sensitive nephrotic syndrome by the life-table method. The effect of partial cortisol substitution was studied as well. Adrenocortical function was determined by a two-hour ACTH test. A response of 50% to 100% of the minimum normal response was diagnosed as "moderate" suppression, and a response of less than 50% as "severe." Post-prednisone adrenocortical function was normal in 99 episodes (49%). Adrenocortical suppression occurred in 102 episodes; of these, 68 were considered moderate and 34 severe. Adrenocortical suppression increased both the initial relapse rate and the final risk of a relapse. Severe suppression was always associated with a relapse, the longest remission time being 0.5 year. In moderate suppression, several long, relapse-free intervals were observed, but the risk of relapse was still higher than in episodes with normal adrenocortical function. Cortisol substitution possibly decreased the risk of a relapse after severe adrenocortical suppression, but not after moderate suppression.
D000293:Adolescent; D000302:Adrenal Cortex / Q000187:drug effects*; D000324:Adrenocorticotropic Hormone; D002648:Child; D002675:Child, Preschool; D003864:Depression, Chemical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000627:therapeutic use; D007223:Infant; D008297:Male; D009404:Nephrotic Syndrome / Q000097:blood / Q000188:drug therapy*; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D012306:Risk; D013997:Time Factors
D000324:Adrenocorticotropic Hormone; D011241:Prednisone; D006854:Hydrocortisone