ESPN 50th Annual Meeting

ESPN 2017


 
Lower prednisone dosing for nephrotic syndrome relapse: a prospective randomized study
Yael Borovitz 1 Orly Haskin 1 Shely Levi 2 Sholamit Kaz 1 HADAS ALFANDARY 1 Miriam Davidovits 1 AMIT DAGAN 1

1- INSTITUTE OF NEPHROLOGY, SCHNEIDER CHILDRENS MEDICAL CENTER OF ISRAEL
2- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv Israel
 
Introduction:

 Most children with idiopathic steroid sensitive nephrotic syndrome (SSNS) will suffer from more than one relapse after diagnosis. Current steroid regimens on first relapse expose patients to different regimens of  daily followed by subsequent  every other day steroids, leading to a high cumulative dose. Previous  studies have reported on a wide range of prednisone regimens.   However there has been no prospective controlled study comparing the efficacy of different prednisone doses to achieve short term remission and its effects on subsequent relapses

Material and methods:

 In this single center randomized controlled study, SSNS children were randomized to receive at relapse 3 different prednisone doses: 1- , 1.5- or 2 mg/kg/day. Patients that didn’t respond after 14 days were switched to 2mg/kg. Time to remission (2 consecutive days with urine protein dipstick < 1) and rate of treatment failure were recorded. Children were followed  for 3 months after this intervention.

Results:

 We enrolled 30 patients (1 mg/kg/day=9; 1.5 mg/kg/day=11; 2 mg/kg/day=10).  Mean age of all cohort was 5.8±3.2 year and disease duration 2±1.5 years, without differences in these 2 parameters between groups. Mean days to response was 8±2.7 (1mg/kg),  9.5±2.3 (1.5mg/kg) and 7.1±1.3 (2mg/kg) without statistical difference between the groups. Two patients, one from 1 mg/kg group and second from 1.5 mg/kg failed to enter remission within the first 14 days and were switched to 2mg/kg. One responded after 3 days, and the second after 2 weeks. Mean cumulative prednisone doses were 22.6±5.1 mg/kg (1mg/kg), 34.9±8.1 mg/kg (1.5mg/kg) and 45.2±3.5 mg/kg (2mg/kg) (p<0.05). Time to subsequent relapse  was not calculated since 20% of the patients were continue with low prednisone dose or started mycophenolate  mofetil

Conclusions:

 In conclusion our results support the use of lower prednisone doses in relapses of SSNS . A daily prednisone dose of 1 or 1.5 mg/kg/day is as effective  as 2mg/kg, leading to a lower cumulative  dose. The use of lower daily prednisone dose may lower its side effects rate.