Increasing the dose of prednisolone during viral infections reduces the risk of relapse in nephrotic syndrome: a randomised controlled trial.
BACKGROUND
Relapses of nephrotic syndrome are often triggered by viral upper respiratory tract infections (URTIs), possibly mediated by cytokine release.


OBJECTIVE
To test, in a randomised double-blind placebo-controlled crossover trial, the hypothesis that a small short-term increase in the dose of prednisolone will reduce the release of cytokines and thereby reduce the risk of relapse.


METHODS
Sequential patients receiving low-dose (<0.6 mg/kg) prednisolone on alternate days as maintenance therapy were recruited. At the first sign of a presumed viral URTI, all children were examined and randomly allocated to take medicine A or B (containing either prednisolone (5 mg) or placebo) in the first viral URTI, and vice versa in the second. If the criteria for diagnosis of a viral URTI were met, the new medicine was prescribed on alternate days for 1 week at the same dose as that of the prednisolone being taken by the patient on an alternate-day basis. A freshly voided urine sample was tested each morning. The presence of 3+ proteinuria for 3 consecutive days was diagnostic of relapse.


RESULTS
48 patients were recruited, and 40 completed the trial (29 male; 11 female). Age at entry ranged from 1.5 to 13.2 (median 5.3) years. The relapse rate after viral URTI was 19/40 (48%) in the placebo group and 7/40 (18%) in the prednisolone group (p = 0.014; two-sided probability using Fisher's exact test).


CONCLUSIONS
Prescribing prednisolone daily for 7 consecutive days at the same dose as that taken by the patient on an alternate-day basis at the onset of a presumed viral URTI significantly reduces the risk of relapse in children with steroid-dependent nephrotic syndrome.
Abeyagunawardena
A S
AS
Department of Paediatrics, University of Peradeniya, Peradeniya, Sri Lanka. asiri26@hotmail.com
Trompeter
R S
RS
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications / Q000517:prevention & control*; D011239:Prednisolone / Q000008:administration & dosage*; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy*; D055502:Secondary Prevention; D013188:Sri Lanka; D016896:Treatment Outcome; D014777:Virus Diseases / Q000150:complications / Q000188:drug therapy*
D005938:Glucocorticoids; D011239:Prednisolone