Weight or body surface area dosing of steroids in nephrotic syndrome: is there an outcome difference?

Abstract

Although prednisone is the treatment of choice for nephrotic syndrome (NS) in childhood, the dosing regimen varies between 60 mg/m2/day, as recommended in early studies, to the often prescribed 2 mg/kg/day dose, which is used in common practice. Mathematical models have demonstrated that weight-based dosing can be less than body surface area (BSA)-based dosing in smaller children. To test our hypothesis that weight-based dosing would result in altered treatment outcomes in children with NS, we analyzed a cohort of 56 children (mean age 5.4 ± 3.8 years) treated with a weight-based dosing regimen. Theoretical underdosing of corticosteroids was tested by calculating a relative underdosing percentage (RUP), which was defined as the dose difference between the theoretical BSA-based dose and the actual weight-based doses divided by the BSA-based dose × 100. We found that the mean “actual” prednisone dose in our patients was 43.6 ± 19.3 mg/day; in contrast, the mean theoretical BSA-based dose was calculated to be 48.8 ± 16.7 mg/day. Among the 56 patients, 43 (76.7%) were initial responders, of whom 58% followed a frequently relapsing (FR) course. RUP was significantly higher in FR (16.6 ± 7.9%) than in infrequent relapsers (8.7 ± 9.8%) (P = 0.03). RUP was not significantly different among initial responders and nonresponders. Based on these results, we conclude that prednisone underdosing, when dosing is prescribed according to weight, does not affect the initial response to treatment, but it does increase the likelihood of a FR course in responders.

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References

  1. 1.

    No authors listed (1981) The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. A report of the International Study of Kidney Disease in Children. J Pediatr 98:561–564

    Article  Google Scholar 

  2. 2.

    Bagga A, Hari P, Srivastava RN (1999) Prolonged versus standard prednisolone therapy for initial episode of nephrotic syndrome. Pediatr Nephrol 13:824–827

    CAS  Article  Google Scholar 

  3. 3.

    Ksiazek J, Wyszynska T (1995) Short versus long initial prednisone treatment in steroid-sensitive nephrotic syndrome in children. Acta Paediatr 84:889–893

    CAS  Article  Google Scholar 

  4. 4.

    Ekka BK, Bagga A, Srivastava RN (1997) Single- versus divided-dose prednisolone therapy for relapses of nephrotic syndrome. Pediatr Nephrol 11:597–599

    CAS  Article  Google Scholar 

  5. 5.

    Hodson EM, Willis NS, Craig JC (2007) Corticosteroid therapy for nephrotic syndrome in children. Cochrane Database Syst Rev:CD001533

  6. 6.

    Feber J, Al-Matrafi J, Farhadi E, Vaillancourt R, Wolfish N (2009) Prednisone dosing per body weight or body surface area in children with nephrotic syndrome: is it equivalent? Pediatr Nephrol 24:1027–1031

    Article  Google Scholar 

  7. 7.

    Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637

    Article  Google Scholar 

  8. 8.

    No authors listed (1979) Nephrotic syndrome in children: a randomized trial comparing two prednisone regimens in steroid-responsive patients who relapse early. Report of the international study of kidney disease in children. J Pediatr 95:239–243

    Article  Google Scholar 

  9. 9.

    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

    CAS  Google Scholar 

  10. 10.

    Brodehl J, Krohn HP, Ehrich JH (1982) The treatment of minimal change nephrotic syndrome (lipoid nephrosis): cooperative studies of the Arbeitsgemeinschaft fur Padiatrische Nephrologie (APN). Klin Padiatr 194:162–165

    CAS  Article  Google Scholar 

  11. 11.

    Ehrich JH, Brodehl J (1993) Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Arbeitsgemeinschaft fur Padiatrische Nephrologie. Eur J Pediatr 152:357–361

    CAS  Article  Google Scholar 

  12. 12.

    Arbeitsgemeinschaft fur Padiatrische Nephrologie (1988) Short versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Lancet 1:380–383

    Google Scholar 

  13. 13.

    No authors listed (1979) Alternate-day versus intermittent prednisone in frequently relapsing nephrotic syndrome. A report of “Arbetsgemeinschaft fur Padiatrische Nephrologie”. Lancet 1:401–403

    Google Scholar 

  14. 14.

    Koskimies O (1982) Problems caused by pharmacologic glucocorticoid treatment of nephrotic syndrome. Klin Padiatr 194:166–167

    CAS  Article  Google Scholar 

  15. 15.

    Lande MB, Gullion C, Hogg RJ, Gauthier B, Shah B, Leonard MB, Bonilla-Felix M, Nash M, Roy S 3rd, Strife CF, Arbus G (2003) Long versus standard initial steroid therapy for children with the nephrotic syndromeA report from the Southwest Pediatric Nephrology Study Group. Pediatr Nephrol 18:342–346

    Article  Google Scholar 

  16. 16.

    Ueda N, Chihara M, Kawaguchi S, Niinomi Y, Nonoda T, Matsumoto J, Ohnishi M, Yasaki T (1988) Intermittent versus long-term tapering prednisolone for initial therapy in children with idiopathic nephrotic syndrome. J Pediatr 112:122–126

    CAS  Article  Google Scholar 

  17. 17.

    MacHardy N, Miles PV, Massengill SF, Smoyer WE, Mahan JD, Greenbaum L, Massie S, Yao L, Nagaraj S, Lin JJ, Wigfall D, Trachtman H, Hu Y, Gipson DS (2009) Management patterns of childhood-onset nephrotic syndrome. Pediatr Nephrol 24:2193–2201

    Article  Google Scholar 

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Correspondence to Sermin A. Saadeh.

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Saadeh, S.A., Baracco, R., Jain, A. et al. Weight or body surface area dosing of steroids in nephrotic syndrome: is there an outcome difference?. Pediatr Nephrol 26, 2167–2171 (2011). https://doi.org/10.1007/s00467-011-1961-3

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Keywords

  • Nephrotic syndrome
  • Prednisone
  • Weight
  • Body-surface area