Use of a low-dose prednisolone regimen to treat a relapse of steroid-sensitive nephrotic syndrome in children.
Relapses of nephrotic syndrome are common and are treated with a course of prednisolone (2 mg/kg/day or 60 mg/m2/day). This is associated with major adverse effects including diabetes, weight gain, hypertension and behavioural problems. This study is a retrospective review examining the success of treating relapses in steroid-sensitive nephrotic syndrome (SSNS) with low-dose prednisolone and the consequences on subsequent relapse rates. Furthermore, a follow-up study looked at the side-effect profile during treatment with high- versus low-dose prednisolone.



Between January 2012 and July 2013, all well children with SSNS presenting with a relapse were advised to start 1 mg/kg prednisolone daily for a maximum of 7 days. In July 2015, we compared the side-effect profile of prednisolone therapy using the parent proxy PedsQL questionnaire for quality of life (QoL).



Fifty patients were included in the study, with a total of 87 relapses. Sixty-one of the 87 relapses (70 %) responded within a week. Treating relapses with a reduced dose of steroids did not adversely affect the relapse rate in the 6 months preceding and following the current relapse (1.01 vs 0.86, p = 0.3). Fifteen parents completed the PedsQL questionnaire. Comparison of scores in each category showed significantly higher values in each domain during treatment with low-dose prednisolone compared with high-dose treatment (35.6 vs 18.3, p < 0.0001; 31.1 vs 15.0, p < 0.001; 38.3 vs 20.1, p < 0.0001).



A low-dose prednisolone regimen was successful in achieving remission in 70 % of relapses of children with SSNS, without adversely affecting the relapse rate. Parent-completed QoL questionnaires showed significantly higher scores on low-dose treatment, indicating better QoL.
Department of Paediatric Nephrology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
Karnika
0000-0002-2549-4452
K
Raja
Department of Paediatric Nephrology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
Ami
A
Parikh
Department of Paediatric Nephrology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
Hazel
H
Webb
Department of Paediatric Nephrology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK. daljit.hothi@gosh.nhs.uk.
Daljit
D
Hothi
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000523:psychology; D010290:Parents; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D011239:Prednisolone
Low-dose prednisolone; PedsQL; Steroid-sensitive nephrotic syndrome (SSNS)
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