Relapse Rate in Daily Single-Dose Prednisolone Therapy for Children with Primary Nephrotic Syndrome

ABSTRACT

Most current references recommend divided doses of prednisolone for the initial treatment of idiopathic minimal change nephrotic syndrome in children, with relapse occuring in the majority of them, but there is little experience concerning single-dose prednisolone therapy, especially considering the relapse rate. In this prospective study on 36 consecutive children with primary nephrotic syndrome, prednisolone [2 mg/kg/day] was used as a single daily dose in 17 patients [SD group], or divided into 3 doses in 19 cases [DD group] who were randomly selected, and relapse rates were compared. The mean age of the patients was 6 years [range 15 months-13 years] and there was no statistically significant difference between the two groups considering age, sex, clinical presentation, laboratory findings at the time of admission and prednisolone side effects. After 4 weeks of full dose prednisolone therapy, the drug was changed to 2 mg/ kg as a single dose every other day in both groups, irrespective of the response. During the third month of therapy, the drug was reduced to 1 mg/kg every other day and it was discontinued after 4 weeks. Relapse rate was compared in steroid responsive patients in both groups [14 in the SD and 11 in the DD group] who were matched for age, sex and paraclinical findings. During the first year of follow-up, in those who were initially steroid responsive, 2 patients in the SD and 6 in the DD group had no relapse. The number of total relapses/year in the SD and DD group were 19 for 12 patients and 8 for 5 patients respectively [p<0.02]. In conclusion, daily single-dose prednisolone therapy in childhood nephrotic syndrome can be effective for induction of remission and is tolerated well by patients but increases the relapse rate significantly