European Journal of Pediatrics

, Volume 152, Issue 4, pp 357–361 | Cite as

Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children

  • J. H. H. Ehrich
  • J. Brodehl
  • Arbeitsgemeinschaft für Pädiatrische Nephrologie
Nephrology/Urology

Abstract

Two regimens of steroid treatment for the initial attack of idiopathic nephrotic syndrome (NS) in children were compared in a controlled prospective multicentre study. Long prednisone therapy consisted of 60 mg/m2 per 24 h for 6 weeks, followed by alternate day 40 mg/m2 per 48 h for 6 weeks. The standard prednisone therapy was 60 mg/m2 per 24 h for 4 weeks, followed by 40 mg/m2 per 48 h for 4 weeks. A total of 71 children with an initial attack of idiopathic NS were allocated at random to the two groups. The cumulative rate of patients with sustained remissions after 2 years was significantly higher after the long course than after the standard treatment (49% vs 19%,P=0.0079). The mean relapse rate per patient at intervals of 3, 6 and 12 months was lower in the long-course prednisone group than in the standard prednisone group, and the proportion of children with frequent relapses during any subsequent 6 months period was lower in the long-course group than in the standard group (29% vs 57%,P=0.03). Mild side-effects of corticosteroid therapy were observed more frequently after long-course prednisone treatment. It is concluded that long-course prednisone therapy of the initial attack of steroid responsive NS is preferable to the standard regimen because it reduces the rate of subsequent relapses without increasing the risk for severe steroidal side-effects.

Key words

Steroid sensitive nephrotic syndrome Prednisone 

Abbreviations

NS

nephrotic syndrome

ISKDC

International Study of Kidney Disease in Children

APN

Arbeitsgemeinschaft für Pädiatrische Nephrologie

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Abramowicz M, Arneil GC, Barnett HL, Barron BA, Edelman CM, Gordillo-PG, Greifer I, Hallman N, Kobayashi O, Tiddens HA (1970) Controlled trial of azathioprine in children with nephrotic syndrome. Lancet I:959–961Google Scholar
  2. 2.
    Arbeitsgemeinschaft für Pädiatrische Nephrologie (1979) Alternate-day versus intermittent prednisone in frequently relapsing nephrotic syndrome. Lancet I:401–403Google Scholar
  3. 3.
    Arbeitsgemeinschaft für Pädiatrische Nephrologie (1988) short versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Lancet I:380–383Google Scholar
  4. 4.
    Arneil GC (1968) Management of the nephrotic syndrome. Arch Dis Child 43:257–262Google Scholar
  5. 5.
    Barnett HL, Schoeneman M, Bernstein J, Edelman CM (1978) The nephrotic syndrome. In: Edelman CM (ed) Pedíatric kidney disease, vol 2. Little, Brown and Company, Boston, pp 695–711Google Scholar
  6. 6.
    Brodehl J, Krohn HP, Ehrich JHH (1982) The treatment of minimal change nephrotic syndrome (lipoidnephrosis): cooperative studies of the Arbeitsgemeinschaft für Pädiatrische Nephrologie (APN). Klin Pädiatr 194:162–165Google Scholar
  7. 7.
    Friedman AL, Chesney RW (1982) Glucocorticoids in renal disease. Am J Nephrol 2:330–341Google Scholar
  8. 8.
    Good RA, Vernier RL, Smith RT (1957) Serious untoward reactions of therapy with cortisone and adrenocorticotrophin in pediatric practice. Pediatrics 19:95–118Google Scholar
  9. 9.
    International Study of Kidney Disease in Children (1981) The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. J Pediatr 98:561–564Google Scholar
  10. 10.
    International Study of Kidney Disease in Children (1982) Early identification of frequent relapsers among children with minimal change nephrotic syndrome. J Pediatr 101:514–518Google Scholar
  11. 11.
    Lam CN, Arneil GC (1968) Long-term dwarfing effects of cortico-steroid treatment of childhood nephrosis. Arch Dis Child 43:589–594Google Scholar
  12. 12.
    Lange K, Wasserman E, Slobody LB (1958) Prolonged intermittent steroid therapy for nephrosis in children and adults. JAMA 168:377–381Google Scholar
  13. 13.
    Leisti S, Koskimies O (1983) Risk of relapse in steroid-sensitive nephrotic syndrome: Effect of stage of post-prednisone adrenocortical suppression. J Pediatr 103:553–557Google Scholar
  14. 14.
    Lieberman E, Heuser E, Gilchrist GS, Donnell GN, Landing BH (1968) Thrombosis, nephrosis and corticosteroid therapy. J Pediatr 73:320–328Google Scholar
  15. 15.
    Saxena KM, Crawford JD (1956) The treatment of nephrosis. N Engl J Med 272:522–526Google Scholar
  16. 16.
    Ueda N, Chihara M, Kawaguchi S, Niionomi Y, Nonada T, Matsumoto J, Ohnishi M, Yasaki T (1988) Intermittent versus long-term tapering prednisone for initial therapy in children with idiopathic nephrotic syndrome. J Pediatr 112:122–126Google Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • J. H. H. Ehrich
    • 1
  • J. Brodehl
    • 1
  • Arbeitsgemeinschaft für Pädiatrische Nephrologie
  1. 1.KinderklinikMedizinische HochschuleHannover 61Germany

Personalised recommendations