Abstract
Background
Relapses of nephrotic syndrome are common and are treated with a course of prednisolone (2 mg/kg/day or 60 mg/m2/day). This is associated with major adverse effects including diabetes, weight gain, hypertension and behavioural problems. This study is a retrospective review examining the success of treating relapses in steroid-sensitive nephrotic syndrome (SSNS) with low-dose prednisolone and the consequences on subsequent relapse rates. Furthermore, a follow-up study looked at the side-effect profile during treatment with high- versus low-dose prednisolone.
Methods
Between January 2012 and July 2013, all well children with SSNS presenting with a relapse were advised to start 1 mg/kg prednisolone daily for a maximum of 7 days. In July 2015, we compared the side-effect profile of prednisolone therapy using the parent proxy PedsQL questionnaire for quality of life (QoL).
Results
Fifty patients were included in the study, with a total of 87 relapses. Sixty-one of the 87 relapses (70 %) responded within a week. Treating relapses with a reduced dose of steroids did not adversely affect the relapse rate in the 6 months preceding and following the current relapse (1.01 vs 0.86, p = 0.3). Fifteen parents completed the PedsQL questionnaire. Comparison of scores in each category showed significantly higher values in each domain during treatment with low-dose prednisolone compared with high-dose treatment (35.6 vs 18.3, p < 0.0001; 31.1 vs 15.0, p < 0.001; 38.3 vs 20.1, p < 0.0001).
Conclusion
A low-dose prednisolone regimen was successful in achieving remission in 70 % of relapses of children with SSNS, without adversely affecting the relapse rate. Parent-completed QoL questionnaires showed significantly higher scores on low-dose treatment, indicating better QoL.
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References
Trompeter RS, Lloyd BW, Hicks J, White RH, Cameron JS (1985) Long-term outcome for children with minimal change nephrotic syndrome. Lancet 325:368–370
International Study of Kidney Disease in Children (1982) Nephrotic syndrome in children: a randomised controlled trial comparing two prednisone regimens in steroid-responsive patients who relapse early. J Pediatr 95:239–243
Soliday E, Grey S, Lande MB (1999) Behavioral effects of corticosteroids in steroid-sensitive nephrotic syndrome. Pediatrics 51:104
Youssef DM, Abdelsalam MM, Abozeid AM, Youssef UM (2013) Assessment of behavior abnormalities of corticosteroids in children with nephrotic syndrome. ISRN Psychiatry 2013:92125
Mehta M, Bagga A, Pande P, Bajaj G, Srivastava RN (1995) Behavior problems in nephrotic syndrome. Indian Pediatr 32:1281–1286
Hall AS, Thorley G, Houtman PN (2003) The effects of corticosteroids on behaviour in children with nephrotic syndrome. Pediatr Nephrol 18:220–1223
Guha P, De A, Ghosal M (2009) Behavior profile of children with nephrotic syndrome. Indian J Psychiatry 51:122–126
Mishra OP, Basu B, Upadhyay SK, Prasad R, Schaefer F (2010) Behavioural abnormalities in children with nephrotic syndrome. Nephrol Dial Transplant 25:2537–2541
Hahn D, Hodson EM, Willis NS, Craig JC (2015) Corticosteroid therapy for nephrotic syndrome in children. Cochrane Database Syst Rev 18:CD001533
KDIGO (2012) Summary of recommendation statements. Chapter 3: steroid-sensitive nephrotic syndrome in children. Kidney Int 2(2):143–153
Varni JW, Seid M, Rode CA (1997) The PedsQL™: measurement model for the pediatric quality of life inventory. Med Care 37:126–139
Varni JW, Seid M, Kurtin PS (2001) PedsQL™ 4.0: reliability and validity of the pediatric quality of life inventory™ version 4.0 generic core scales in healthy and patient populations. Med Care 39:800–812
Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale, NJ
Koskimies O, Vilska J, Rapola J, Hallman N (1982) Long-term outcome of primary nephrotic syndrome. Arch Dis Child 57:544–548
Tarshish P, Tobin JN, Bernstein J, Edelmann CM Jr (1997) 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 8:769–776
Vance JC, Fazan LE, Satterwhite B, Pless IB (1980) Effects of nephrotic syndrome on the family: a controlled study. Pediatrics 65:948–955
Mitra S, Banerjee S (2011) The impact of pediatric nephrotic syndrome on families. Pediatr Nephrol 26:1235–1240
Soliday E, Kool E, Lande MB (2000) Psychosocial adjustment in children with kidney disease. J Pediatr Psychol 25:93–103
Mishra K, Ramachandran S, Firdaus S, Rath B (2015) The impact of pediatric nephrotic syndrome on parents’ health-related quality of life and family functioning: an assessment made by the PedsQL 4.0 family impact module. Saudi J Kidney Dis Transpl 26:285–292
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Raja, K., Parikh, A., Webb, H. et al. Use of a low-dose prednisolone regimen to treat a relapse of steroid-sensitive nephrotic syndrome in children. Pediatr Nephrol 32, 99–105 (2017). https://doi.org/10.1007/s00467-016-3458-6
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DOI: https://doi.org/10.1007/s00467-016-3458-6