ABSTRACT
In order to avoid using cytotoxic drugs and to minimize prednisolone side effects in frequent relapsing or steroid-dependent idiopathic nephrotic syndrome, 35 patients, 3 to 15 [mean= 8.1] years of age, were studied. While in remission for at least 6 weeks, the dose of prednisolone was reduced to 0.1-0.37 [mean= 0.23] mg/kg/day as a single dose for 12 to 72 [mean= 27.6] months. It was followed by a tapering method, with gradual increase in the interval instead of decrease in the dose for about 10 to 12 months, and about 18.4 months follow-up without treatment. About 54.3% of the patients had no relapse during the treatment period and the relapse rate per patient per year was 3.94 during the preceding 12 months before the study, 0.51 during treatment [p<0.001] and 0.23 after discontinuation of the drug. Each relapse was treated by a standard dose of prednisolone for 2 months and then the low dose regimen was resumed. The patients tolerated the drug well with minimal side effects. It is concluded that long term, low-dose daily prednisolone therapy followed by gradual increase in the interval is a safe, well-tolerated and effective method of maintaining prolonged remission in most children with frequent relapsing idiopathic nephrotic syndrome