[Corticosteroid treatment for a first episode of steroid-sensitive nephrotic syndrome (SSNS) in children: guideline from the Italian Society of Nephrology].
BACKGROUND
The current 3rd edition of the Italian Society of Nephrology guidelines has been drawn up to summarize evidence of key intervention issues on the basis of systematic reviews (SR) of randomized trials (RCT) or RCT data only. In the present guideline, evidence of the use of corticosteroid treatment for a first episode of steroid-sensitive nephrotic syndrome (SSNS) in children is presented.


METHODS
SR of RCT and RCT on SSNS therapeutic interventions were identified referring to a Cochrane Library and Renal Health Library search (2005 update). Results. One SR including 15 RCT was available on this topic. Methodological quality of available RCT was suboptimal according to current methodological standards.


RESULTS
In children with a first episode of SSNS, corticosteroids administered for 3 months or more compared with 2 months' administration are associated with a significant reduction in the risk of relapse at 6, 12 and 24 months, and in frequent relapsing rates, even though complications did not seem significantly increased (psychological, ocular, gastrointestinal disorders, hypertension, growth delay, Cushingoid syndrome, infection and osteoporosis) (evidence from SR). 6-month compared to 3-month treatment regimens are associated with a significant reduction in the risk of relapse at 12-24 months (evidence from SR). Increasing steroids cumulative doses are associated with increasing improvements in the risk of relapse (evidence from RCT). The risk of relapse at 12-24 months correlates inversely with duration of treatment (evidence from SR).


CONCLUSIONS
In SSNS children, current available evidence supports the hypothesis that primary intervention should be a high dose of corticosteroids administered for 3 months or more. Further studies are necessary to test this hypothesis in adult patients.
Lupo
A
A
Italian Society of Nephrology - Italy.
Pozzi
C
C
Passerini
P
P
Cagnoli
L
L
Stratta
P
P
Manno
C
C
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D009404:Nephrotic Syndrome / Q000188:drug therapy*; D012008:Recurrence
D000305:Adrenal Cortex Hormones