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Long-term, low-dose prednisolone therapy in frequently relapsing nephrotic syndrome


The efficacy of daily administration of a small dose of prednisolone was examined in 21 patients with corticosteroid-responsive, frequently relapsing nephrotic syndrome (FRNS). After induction of remission of a third or subsequent relapse with a 6-week course of prednisolone (standard therapy with prednisolone, STP), this drug was continued in a single daily dose of 0.25 mg/kg body weight (low-dose prednisolone, LDP) for 18 months. Relapses occurring during this period were treated with STP, following which LDP therapy was resumed. The historical controls comprised 14 patients with FRNS in whom relapses were treated with STP and who were observed over a minimum period of 30 months. The two groups were comparable for age at the onset of nephrotic syndrome and sex. Twenty patients completed LDP therapy, during which 12 had no relapse, 6 had infrequent and 2 frequent relapses (1 patient became steroid dependent and was taken off LDP). Twelve patients were followed for 12–42 months after stoppage of LDP during this period 7 had no relapse, 4 had infrequent relapses and 1 showed steroid dependence. The number of relapses during LDP therapy (0.5/patient per year) was significantly less (P<0.001) than in the preceding 12 months (3.62/patient per year), and continued to remain low during the following 12 months (0.6/patient per year). Whereas the frequency of relapses in the LDP group was similar to that in the historical control group in the 1st year of comparison, it was significantly less during LDP therapy (0.5/patient per year versus 2.25/patient per year). No side effects were observed in patients on the LDP regimen, at the end of which the height percentiles improved in 6 patients and remained unchanged in 14. Our observations indicate that long-term therapy with a small daily dose of prednisolone can significantly reduce the number of relapses in patients with FRNS, and that the beneficial effect may continue even after its stoppage.

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  1. 1.

    Barnett HL, Schoeneman M, Bernstein J, Edelmann CM (1978) Minimal change nephrotic syndrome. In: Edelmann CM (ed) Pediatric kidney disease, 2nd edn. Little Brown, Boston, pp 695–711

  2. 2.

    McEnery PT, Strife CF (1982) Nephrotic syndrome in childhood. Management and treatment in patients with minimal change disease, mesangial proliferation, or focal glomerulosclerosis. Pediatr Clin North Am 89:875–894

  3. 3.

    Polito C, Oporto MR, Totino SF, LaManna A, DiToro R (1986) Normal growth of nephrotic children during long-term alternate day prednisolone therapy. Acta Paediatr Scand 75:245–250

  4. 4.

    Trompeter RS (1989) Immunosuppressive therapy in the nephrotic syndrome in children. Pediatr Nephrol 3:194–200

  5. 5.

    Niaudet P, Broyer M, Habib R (1991) Treatment of idiopathic nephrotic syndrome with cyclosporin A in children. Clin Nephrol 35: [Suppl 1]:S31-S36

  6. 6.

    Kitano Y, Yoshikawa N, Tanaka R, Nakamura H, Ninomiya M, Ito H (1990) Ciclosporin treatment in children with steroid-dependent nephrotic syndrome. Pediatr Nephrol 4:474–477

  7. 7.

    Srivastava RN, Mayekar G, Anand R, Choudhry VP, Ghai OP, Tandon HD (1975) Nephrotic syndrome in Indian children. Arch Dis Child 50:626–630

  8. 8.

    Srivastava RN, Agarwal RK, Choudhry VP, Moudgil A, Bhuyan UN, Sunderam KR (1985) Cyclophosphamide therapy in frequently relapsing nephrotic syndrome with and without steroid dependence. Int J Pediatr Nephrol 6:245–250

  9. 9.

    Ghai OP (1990) Growth and development. In: Ghai OP (ed) Essential pediatrics, 2nd edn. Interprint, New Delhi, p 5

  10. 10.

    Arbeitsgemeinschaft für Pädiatrische Nephrologie (1981), Alternate-day prednisone is more effective than intermittent prednisone in frequently relapsing nephrotic syndrome. Eur J Pediatr 135: 229–237

  11. 11.

    Elzouki AY, Jaiswal OP (1988) Long-term small dose prednisolone therapy in frequently relapsing nephrotic syndrome of childhood. Clin Pediatr (Phila) 27:387–392

  12. 12.

    Schoeneman MJ (1983) Minimal change nephrotic syndrome. Treatment with low doses of hydrocortisone. J Pediatr 102:791–793

  13. 13.

    Wingen AM, Muller-Wiefel DE, Scharer K (1990) Comparison of different regimens of prednisone therapy in frequently relapsing nephrotic syndrome. Acta Paediatr Scand 79:305–310

  14. 14.

    Chiu J, McLain PN, Drummond KN (1973) A controlled prospective study of cyclophosphamide in relapsing corticosteroid responsive minimal-lesion nephrotic syndrome in childhood. J Pediatr 82: 607–613

  15. 15.

    Arbeitsgemeinschaft für Pädiatrische Nephrologie (1982) Effect of cytotoxic drugs in frequently relapsing nephrotic syndrome with and without steroid dependence. N Engl J Med 306:451–454

  16. 16.

    Mongeau JG, Robiataille PO, Roy F (1988) Clinical efficacy of levamisole in the treatment of primary nephrosis in children. Pediatr Nephrol 2:398–401

  17. 17.

    British Association for Paediatric Nephrology (1991) Levamisole for corticosteroid-dependent nephrotic syndrome in childhood. Lancet 337:1555–1557

  18. 18.

    Myers BD, Newton L (1991) Cyclosporine-induced chronic nephropathy: an obliterative microvascular renal injury. J Am Soc Nephrol 2 [Suppl 1]:S45-S52

  19. 19.

    Ponticelli C, Fogazzi GB (1989) Methylprednisolone pulse therapy for primary glomerulonephritis. Am J Nephrol 9:S41-S46

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Correspondence to Rajendra N. Srivastava.

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Srivastava, R.N., Vasudev, A.S., Bagga, A. et al. Long-term, low-dose prednisolone therapy in frequently relapsing nephrotic syndrome. Pediatr Nephrol 6, 247–250 (1992).

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Key words

  • Nephrotic syndrome
  • Frequent relapses
  • Low-dose prednisolone therapy