Prednisone dosing per body weight or body surface area in children with nephrotic syndrome—is it equivalent?
- 292 Downloads
The current guidelines recommend a dosage of prednisone of 60 mg/m2 body surface area per day (BSA PRED) for the initial therapy of nephrotic syndrome (NS). Alternatively, a dosage of 2 mg/kg body weight per day (W PRED) can be used. We hypothesized that the BSA PRED and W PRED are not equivalent and analyzed the differences between BSA PRED calculated with various formulas for body surface area (BSA), W PRED and the dose of prednisone prescribed for our patients. We performed a retrospective chart review of the patients at their initial presentation of NS. Thirty-three children were included, of median age 3.34 years at presentation. The W PRED was significantly lower than BSA PRED (P < 0.05), with a median W PRED:BSA PRED ratio of 0.85 [interquartile range (IQR) 0.8 to 0.9]. The difference between W PRED and BSA PRED decreased proportionally to patients’ weights up to 30 kg. No differences were noted between the various BSA formulas using both weight and height for the calculation of BSA. The Bland–Altman analysis showed a proportional error between W PRED and BSA PRED up to the average daily dose of 60 mg, with a mean bias of 0.86 (95% limits of agreement = 0.68 to 1.05). Ten out of the 33 patients (30%) were given a lower than recommended BSA PRED dose by more than 5 mg/day. In conclusion, the dosage of prednisone at 2 mg/kg per day versus 60 mg/m2 per day is not equivalent for patients with weights <30 kg and/or dose <60 mg/day.
KeywordsPrednisone dose Children Nephrotic syndrome Weight Body surface area
- 2.Arbeitsgemeinschaft für Pädiatrische Nephrologie (1988) Short versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Arbeitsgemeinschaft für Pädiatrische Nephrologie. Lancet 1:380–383Google Scholar
- 4.Ehrich JH, Brodehl J (1993) Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Arbeitsgemeinschaft für Pädiatrische Nephrologie. Eur J Pediatr 152:357–361Google Scholar
- 5.Gauthier B, Trachtman H (1999) Pharmacological treatment of nephrotic syndrome. Drugs Today (Barc) 35:13–26Google Scholar
- 7.Hiraoka M, Tsukahara H, Matsubara K, Tsurusawa M, Takeda N, Haruki S, Hayashi S, Ohta K, Momoi T, Ohshima Y, Suganuma N, Mayumi M, West Japan Cooperative Study Group of Kidney Disease in Children (2003) A randomized study of two long-course prednisolone regimens for nephrotic syndrome in children. Am J Kidney Dis 41:1155–1162PubMedCrossRefGoogle Scholar
- 12.Indian Pediatric Nephrology Group, Indian Academy of Pediatrics (2008) Management of steroid sensitive nephrotic syndrome: revised guidelines. Indian Pediatr 45:203–214Google Scholar
- 14.Lande MB, Gullion C, Hogg RJ, Gauthier B, Shah B, Leonard MB, Bonilla-Felix M, Nash M, Roy S, Strife CF, Arbus G (2003) Long versus standard initial steroid therapy for children with the nephrotic syndrome. A report from the Southwest Pediatric Nephrology Study Group. Pediatr Nephrol 18:342–346PubMedGoogle Scholar
- 15.Hodson EM, Willis NS, Craig JC (2007) Corticosteroid therapy for nephrotic syndrome in children. Cochrane Database Syst Rev (4):CD001533Google Scholar
- 17.Current JD (1998) A linear equation for estimating the body surface area in infants and children. Internet J Anesthesiol 2:2Google Scholar
- 19.DuBois D, DuBois EF (1916) A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 17:863–871Google Scholar
- 22.Sharkey I, Boddy AV, Wallace H, Mycroft J, Hollis R, Picton S, Chemotherapy Standardisation group of the United Kingdom Children’s Cancer Study Group (2001) Body surface area estimation in children using weight alone: application in paediatric oncology. Br J Cancer 85:23–28PubMedCrossRefGoogle Scholar