Skip to main content

Advertisement

SpringerLink
Log in

Is two month initial prednisolone treatment for nephrotic syndrome inferior to longer duration therapy ?

  • Journal Club
  • Published:
Indian Pediatrics Aims and scope Submit manuscript

Summary

This multi-center randomized trial [1] in children with steroid sensitive nephrotic syndrome (NS) compared prednisolone therapy for 2 months versus 6 months. Authors evaluated time to occurrence of frequent relapse, time to first relapse, and various adverse events in 255 children (1–15 years) from 90 Japanese hospitals presenting with first episode of NS. Those who achieved remission within 3 weeks of prednisolone therapy were randomized to either 6 months therapy [60 mg/m2 daily for 4 wk, gradually (4 weekly) tapering alternate day doses for next 24 wk] or 2 months therapy (60 mg/m2 daily for 4 wk, 40 mg/m2 alternate day for 4 wk) with oral prednisolone. Children were followed up for at least 2 years. The authors reported comparable (i) time to frequent relapses (RR 0.86, 95% CI 0.64, 1.16), (ii) episodes of relapse (RR 0.92, 95% CI 0.75, 1.14), (iii) frequent relapses (RR 0.99, 95% CI 0.72, 1.38), (iv) time to first relapse, (v) relapse rate per person-year, and (vi) adverse effects (hypertension, cushingoid facies, glaucoma, and elevated hepatic enzymes). The authors also presented a meta-analysis comparing trials using 2–3 versus 5–6 months therapy, and reported comparable results. They suggested that 2 months of prednisolone is not inferior to 6 months therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Yoshikawa N, Nakanishi K, Sako M, Oba MS, Mori R, Ota E, et al., for the Japanese Study Group of Kidney Disease in Children. A multicenter randomized trial indicates initial prednisolone treatment for childhood nephrotic syndrome for two months is not inferior to six-month treatment. Kidney Int. 2014;doi 10.1038/ki.2014.260.

    Google Scholar 

  2. Tarshish P, Tobin JN, Bernstein J, Edelmann CM Jr. Prognostic significance of the early course of minimal change nephrotic syndrome: Report of the International Study of Kidney Disease in Children. J Am Soc Nephrol. 1997;8:769–76.

    CAS  PubMed  Google Scholar 

  3. Ehrich JH, Brodehl J. Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Arbeitsgemeinschaft fur Padiatrische Nephrologie. Eur J Pediatr. 1993;152:357–61.

    Article  CAS  PubMed  Google Scholar 

  4. Hodson EM, Willis NS, Craig JC. Corticosteroid therapy for nephrotic syndrome in children. Cochrane Database Syst Rev. 2007;4:CD001533.

    PubMed  Google Scholar 

  5. Teeninga N, Kist-van Holthe J, van Rijskwijk N, Hop WC, Wetzels JF, et al. Extending prednisolone therapy does not reduce relapse in childhood nephrotic syndrome. J Am Soc Nephrol. 2012;24:149–59.

    Article  PubMed Central  Google Scholar 

  6. Sinha A, Saha A, Kumar M, Sharma S, Afzal K, Mehta A, et al. Extending initial prednisolone treatment in a randomized control trial from 3- to 6-months did not significantly influence the course of illness in children with steroid sensitive nephrotic syndrome. Kidney Int. 2014;doi: 10.1038/ki.2014.240.

    Google Scholar 

  7. Bagga A, Ali U, Banerjee S, Kanitkar M, Phadke KD, Senguttuvan P, et al. Indian Pediatric Nephrology Group, Indian Academy of Pediatrics. Management of steroid sensitive nephrotic syndrome: Revised guidelines. Indian Pediatr. 2008;45:203–14.

    PubMed  Google Scholar 

  8. Kidney Disease Improving Global Outcomes (KDIGO) Glomerulonephritis Work Group. KDIGO Clinical Practice Guideline for Glomerulonephritis. Kidney Int. 2012; Suppl 2:139–274.

    Article  Google Scholar 

  9. Samuel S, Bitzan M, Zappitelli M, Dart A, Mammen C, Pinsk M, et al. Canadian Society of Nephrology Commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis: Management of nephrotic syndrome in children. Am J Kidney Dis. 2014;63:354–62.

    Article  PubMed  Google Scholar 

  10. Bagga A, Hari P, Srivastava RN. Prolonged versus standard prednisolone therapy for initial episode of nephrotic syndrome. Pediatr Nephrol. 1999;13:824–27.

    Article  CAS  PubMed  Google Scholar 

  11. Arneil GC. The nephrotic syndrome. Pediatr Clin North Am. 1971;18:547–59.

    CAS  PubMed  Google Scholar 

  12. Koskimies O, Vilska J, Rapola J. Long-term outcome of primary nephrotic syndrome. Arch Dis Child 1982;57:544–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Nakanihi K, Iijima K, Ishikura K, Hataya H, Sasaki S, Honda M, et al. Two-year outcome of the ISKDC regimen and frequent-relapsing risk in children with idiopathic nephrotic syndrome. Clin J Am Soc Nephrol. 2013;8:756–62.

    Article  Google Scholar 

  14. Hodson EM, Craig JC. Corticosteroid therapy for steroidsensitive nephrotic syndrome in children: Dose or duration? J Am Soc Nephrol. 2013;24:7–9.

    Article  CAS  PubMed  Google Scholar 

  15. Bagga A, Indian Pediatric Nephrology Group, Indian Academy of Pediatrics. Revised guidelines for management of steroid-sensitive nephrotic syndrome. Indian J Nephrol 2008;18:31–9.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Gulati S, Ahmed M, Sharma RK, Gupta A, Pokhariyal S. Comparison of abrupt withdrawal versus slow tapering regimen of prednisolone therapy in the management of first episode of steroid responsive childhood idiopathic nephrotic syndrome [abstract]. Nephrol Dial Transplant. 2001;16:A87.

    Article  Google Scholar 

  17. Hiraoka M, Tsukahara H, Haruki S, Hayashi S, Takeda N, Miyagawa K, et al. Older boys benefit from higher initial prednisolone therapy for nephrotic syndrome. The West Japan Cooperative Study of Kidney Disease in Children. Kidney Int. 2000; 58:1247–52.

    Article  CAS  PubMed  Google Scholar 

  18. Hiraoka M, Tsukahara H, Matsubara K, Tsurusawa M, Takeda N, Haruki S, et al. A randomized study of two long course prednisolone regimens for nephrotic syndrome in children. Am J Kidney Dis. 2003;41:1155–62.

    Article  CAS  PubMed  Google Scholar 

  19. Jayantha UK. Comparison of ISKDC regime with a six month steroid regime in the treatment of steroid sensitive nephrotic syndrome [abstract]. 7th Asian Congress of Pediatric Nephrology; 2000 Nov 1–4; Singapore. 2000.

    Google Scholar 

  20. Ksiazek J, Wyszynska T. Short versus long initial prednisone treatment in steroid-sensitive nephrotic syndrome in children. Acta Paediatr. 1995;84:889–93.

    Article  CAS  PubMed  Google Scholar 

  21. Mishra OP, Thakur N, Mishra RN, Prasad R. Prolonged versus standard prednisolone therapy for initial episode of idiopathic nephrotic syndrome. J Nephrol. 2012; 25:394–400.

    Article  CAS  PubMed  Google Scholar 

  22. Norero C, Delucchi A, Lagos E, Rosati P. Initial therapy of primary nephrotic syndrome in children: Evaluation in a period of 18 months of two prednisone treatment schedules. Chilean Co-operative Group of Study of Nephrotic Syndrome in Children. Revista Medica de Chile. 1996;124:567–72.

    CAS  PubMed  Google Scholar 

  23. Paul SK, Muinuddin G, Jahan S, Begum A, Rahman MH, Hossain MM. Long versus standard initial prednisolone therapy in children with idiopathic nephrotic syndrome. Mymensingh Med J. 2014;23:261–7.

    CAS  PubMed  Google Scholar 

  24. Pecoraro C, Caropreso MR, Malgieri G, Ferretti AVS, Raddi G, Piscitelli A, et al. Therapy of first episode of steroid responsive nephrotic syndrome: A randomised controlled trial. Nephrol Dial Transplant. 1982;3:45.

    Google Scholar 

  25. Ueda N, Chihara M, Kawaguchi S, Niimomi Y, Nonada T, Matsumoto J, et al. Intermittent versus long-term tapering prednisolone for initial therapy in children with idiopathic nephrotic syndrome. J Pediatr. 1988;112:122–6.

    Article  CAS  PubMed  Google Scholar 

  26. Yoshikawa N, Ito H, Takehoshi Y, Honda M, Awazu M, Iijima K, et al. Standard versus long-term prednisolone with Sairei-to in childhood steroid-responsive nephrotic syndrome: a prospective controlled study. Nippon Jinzon Gakkai Shi. Japanese J Nephrol. 1998;40:587–90.

    CAS  Google Scholar 

  27. Kleinknecht C, Broyer M, Parchoux B, Loriat C, Nivet H, Palcoux JB, et al. Comparison of short and long treatment at onset of steroid sensitive nephrosis (SSN). Preliminary results of a multicenter controlled trial for the French Society of Pediatric Nephrology.

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, AIIMS, New Delhi, India

    Aditi Sinha & Arvind Bagga

  2. Department of Pediatric Nephrology, St John’s Medical College, Bangalore, India

    Arpana Iyengar

  3. Department of Pediatrics, PGIMER, Chandigarh, India

    Joseph L. Mathew

Authors
  1. Aditi Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arvind Bagga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Arpana Iyengar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph L. Mathew
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aditi Sinha.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sinha, A., Bagga, A., Iyengar, A. et al. Is two month initial prednisolone treatment for nephrotic syndrome inferior to longer duration therapy ?. Indian Pediatr 51, 811–817 (2014). https://doi.org/10.1007/s13312-014-0508-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13312-014-0508-7

Keywords

Search

Navigation