LONG VERSUS STANDARD INITIAL STEROID THERAPY FOR CHILDREN WITH IDIOPATHIC NEPHROTIC SYNDROME
ABSTRACT: Two regimens of
steroid treatment for the first episodes of idiopathic nephrotic syndrome in
children were compared to address whether a longer initial course provides
superior protection against relapse without increased adverse effects. The
standard regimen consisted of prednisone 60 mg/m2 or 2 mg/kg per day for 4
weeks, followed by 40 mg/m2 or 1.5 mg/kg alternate-day prednisone for 4 weeks.
The long regimen consisted of daily
prednisone of 60 mg/m2 or 2 mg/kg for 6 weeks, followed by alternate-day
prednisone 40 mg/m2 or 1.5 mg/kg for 6 weeks. Methods: A randomized clinical
trial was conducted to children with
nephrotic syndrome hospitalized at Department of Child Health Dr.
Soetomo Teaching Hospital Surabaya. All patients were followed one year
minimally after the treatment was stopped.
Results: Eighty-one children with nephrotic syndrome aged 2-15 years old
were randomized into 33 children receiving long (12-week) and 48 children
receiving standard (8-week) initial steroid therapy. The time to first relapse
in the long regimen group and standard group was 272.28 ± 158.76 days and
238.02 ± 144.28 days, respectively (p = 0.32). The percentage of patients with
no relapse in 6 and 12 months after initial prednisone withdrawal was 75.8% and
60.6% in the long regimen group and 66.7% and 54.2% in the standard group,
respectively. The percentage of children with 1 relapse in 6 and 12 months
after initial prednisone withdrawal was 21.2% and 21.2% in the long regimen
group and 33.3% and 29.2% in the standard group, respectively. The percentage
of patients with 2 relapses in 6 and 12 months was 3.0% and 12.1% in the long
regimen group and 0% and 14.6% in the standard group, respectively. No significant
difference showed between the two groups (p = 0.51). Conclusions: The long initial prednisone
therapy may delay occurrence of the first relapses and reduced the subsequent
rate of relapses compared to the standard regimen, but statistically there were
no significant differences.
Author: Mohammad Sjaifullah
Noer
Journal Code: jpkedokterangg050039
