Short courses of daily prednisolone during upper respiratory tract infections reduce relapse frequency in childhood nephrotic syndrome.
BACKGROUND
Relapses of childhood nephrotic syndrome (NS) are frequently precipitated by viral upper respiratory tract infections (URTIs). A review of the literature reveals that in patients with steroid-dependent NS on alternate day corticosteroids, a short course of daily corticosteroid therapy during the course of an URTI may reduce relapse frequency.


OBJECTIVE
To assess the effect of a short course of low-dose corticosteroid therapy during the course of an URTI on relapse frequency in patients with steroid-sensitive NS who have not been taking any treatment for a minimum period of 3 months.


METHODS
A double-blind placebo-controlled crossover trial was conducted on 48 patients with idiopathic NS who had not been receiving corticosteroid therapy for a minimum of 3 months. Patients were randomized into two groups. Group A received 5 days of daily prednisolone at 0.5 mg/kg at the onset of an URTI while group B received 5 days of placebo. Both groups were followed up for 1 year and the URTI-induced relapse frequency was noted. A crossover was performed during the next year, with group A receiving placebo and group B receiving prednisolone.


RESULTS
Thirty-three patients completed the study. In the treatment group, 115 episodes of URTI led to 11 relapses while in the control group 101 episodes of URTI led to 25 relapses. There was no significant difference between the mean number of URTIs between the treatment and control groups. The treatment group had significantly less relapses compared to the control group (p = 0.014). Within the treatment group, 65.6% did not relapse, while the remainder had a single relapse. In contrast, only 40.6% of the control group remained in remission while 40.6% suffered a single relapse and 18.8% had two or more relapses.


CONCLUSIONS
Prescribing a short course of daily corticosteroids during an URTI significantly reduces the frequency of URTI-induced relapse in patients with steroid-responsive NS who are off corticosteroid therapy.
Faculty of Medicine, Department of Paediatrics, University of Peradeniya, Peradeniya, Sri Lanka. asiriabey26@gmail.com.
Asiri S
AS
Abeyagunawardena
Faculty of Medicine, Department of Paediatrics, University of Peradeniya, Peradeniya, Sri Lanka.
R S
RS
Thalgahagoda
Faculty of Medicine, Department of Paediatrics, University of Peradeniya, Peradeniya, Sri Lanka.
Pathum V
PV
Dissanayake
Out-patient Department of Medicine, Teaching Hospital Peradeniya, Peradeniya, Sri Lanka.
Shamali
S
Abeyagunawardena
Faculty of Medicine, Department of Pharmacology, University of Peradeniya, Peradeniya, Sri Lanka.
Y A
YA
Illangasekera
Faculty of Medicine, Department of Paediatrics, University of Peradeniya, Peradeniya, Sri Lanka.
Umeshi I
UI
Karunadasa
Centre for Nephrology, University College London, Royal Free Campus, London, UK.
Richard S
RS
Trompeter
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D009404:Nephrotic Syndrome / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D010919:Placebos; D011239:Prednisolone / Q000627:therapeutic use*; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D055502:Secondary Prevention / Q000379:methods*; D013188:Sri Lanka / Q000453:epidemiology; D016896:Treatment Outcome
D005938:Glucocorticoids; D010919:Placebos; D011239:Prednisolone
Prednisolone; Relapse; Steroid-sensitive nephrotic syndrome; Viral respiratory infections