Long-term tapering regimen of prednisolone for the initial episode of nephrotic syndrome

Background: Childhood nephrotic syndrome (NS) has a relapsing-remitting course resulting in a significant corticosteroid burden or a prescription of cytotoxic immunosuppressive therapy. The ideal steroid regimen for the initial episode remains elusive.

Objective: This study was conducted at a single centre to assess the outcome of a longer regimen of prednisolone for the initial episode of childhood NS in comparison to the shorter regimen used earlier.

Methods: The clinical records of children with NS were stored manually since 1994 and electronically since 2002. From 1994 to 2002 all patients attending with the initial episode of NS were prescribed 60mg/m² prednisolone for 4 weeks followed by 40mg/m²on alternate days for 4 weeks (short term therapy / ST). From 2002 the initial episode was treated with 60mg/m² prednisolone for 4 weeks, followed by 60mg/m² on alternate days for 2 weeks tapering by 10mg/m² every 2 weeks over a period of 12 weeks (long term therapy / LT). The outcome of patients treated with ST over a period of 8 years was compared with patients treated with LT for 8 years.

Results: Fifty eight children were treated with ST and 112 with LT. The relapse rate with LT was 12.4% at 6 months, 30.5% at 12 months and 48% at 24 months of the study compared to the 31.5% at 6 months 61% at 12 months and 81% at 24 months for ST. The mean time period for the first relapse to occur was 22.8 months for LT, whereas this was 12.5 months for ST.

Conclusion: A long term tapering regimen is superior in maintaining sustained remission compared to short term therapy for the first episode of childhood NS.

Sri Lanka Journal of Child Health, 2017; 46(4): 331-336