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Treatment of idiopathic nephrotic syndrome at onset: a comparison between 8- and 12-week regimens in everyday clinical practice

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Abstract

Background

Optimal steroid treatment at onset of idiopathic nephrotic syndrome is still debated. The aim of this study was to analyze the clinical outcome at 24 months of follow-up in patients admitted to our unit for the first episode of steroid-sensitive nephrotic syndrome comparing two different steroid regimens.

Methods

We collected data on patients treated from 1992 to 2007 with prednisone according to the International Study on Kidney Diseases in Children 8-week regimen and since 2008 according to the Arbeitsgemeinschaft fur Padiatrische Nephrologie 12-week regimen. The primary outcome was to evaluate cumulative prednisone dosage at 12 and 24 months of follow-up in the two groups. As secondary outcomes, we considered mean relapse rate per patient; number of children without relapses at 6, 12, and 24 months; and number of patients who developed frequent relapses and steroid-dependent disease.

Results

Data were collected on 127 patients. Sixty-one subjects received the 8-week regimen and 66 the 12-week regimen. The mean cumulative prednisone dose at 12 and 24 months was not different, and the rate of patients without relapses was lower at 6 and 12 months in patients treated with the 8-week course, while no difference was observed at 24 months.

Conclusions

Despite the limitations of a retrospective study with limited follow-up, our data indicate that switching treatment from a shorter to a longer scheme did not improve the clinical outcome at 24 months of observation.

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Abbreviations

INS:

Idiopathic nephrotic syndrome

SSNS:

Steroid-sensitive nephrotic syndrome

FRNS:

Frequently relapsing nephrotic syndrome

SDNS:

Steroid-dependent nephrotic syndrome

ISKDC:

International Study on Kidney Diseases in Children

PDN:

Prednisone

APN:

Arbeitsgemeinschaft fur Padiatrische Nephrologie

8W:

8 Weeks

12W:

12 Weeks

MMF:

Mycophenolate mofetil

RCTs:

Randomized controlled studies

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Authors and Affiliations

  1. Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio, 4, 00165, Rome, Italy

    Laura Lucchetti, Alessandra Gianviti, Marina Vivarelli, Francesco Emma & Laura Massella

  2. Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy

    Antonio Gatto

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  1. Laura Lucchetti
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  2. Antonio Gatto
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Correspondence to Laura Massella.

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Lucchetti, L., Gatto, A., Gianviti, A. et al. Treatment of idiopathic nephrotic syndrome at onset: a comparison between 8- and 12-week regimens in everyday clinical practice. Pediatr Nephrol 38, 2101–2106 (2023). https://doi.org/10.1007/s00467-022-05824-7

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