Dosing of glucocorticosteroids in nephrotic syndrome

Mehls, Otto; Hoyer, Peter F.

doi:10.1007/s00467-011-1993-8

Cited by 14 publications

(8 citation statements)

References 26 publications

(33 reference statements)

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“…Recent studies have shown that the PDN dose of 2 mg/kg/day or 60 mg/m 2 /day cannot be considered equivalent for patients who weigh <30 kg [11]. Whether these different choices in PDN dosing have clinicl relevance is still a matter of debate [12, 13]; however, we decided to adopt the same dosage (body surface area dosing) for all our patients in order to avoid any hypothetical bias when evaluating the results of the therapy.We suggest that PDN be given at 60 mg/m 2 /day, with a maximum dose of 60 mg/day. …”

Section: Corticosteroid Use For the First Episode Of Insmentioning

confidence: 99%

The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I - Diagnosis and treatment of the first episode and the first relapse

et al. 2017

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This consensus document is aimed at providing an updated, multidisciplinary overview on the diagnosis and treatment of pediatric nephrotic syndrome (NS) at first presentation. It is the first consensus document of its kind to be produced by all the pediatric nephrology centres in Italy, in line with what is already present in other countries such as France, Germany and the USA. It is based on the current knowledge surrounding the symptomatic and steroid treatment of NS, with a view to providing the basis for a separate consensus document on the treatment of relapses. NS is one of the most common pediatric glomerular diseases, with an incidence of around 2–7 cases per 100000 children per year. Corticosteroids are the mainstay of treatment, but the optimal therapeutic regimen for managing childhood idiopathic NS is still under debate. In Italy, shared treatment guidelines were lacking and, consequently, the choice of steroid regimen was based on the clinical expertise of each individual unit. On the basis of the 2015 Cochrane systematic review, KDIGO Guidelines and more recent data from the literature, this working group, with the contribution of all the pediatric nephrology centres in Italy and on the behalf of the Italian Society of Pediatric Nephrology, has produced a shared steroid protocol that will be useful for National Health System hospitals and pediatricians. Investigations at initial presentation and the principal causes of NS to be screened are suggested. In the early phase of the disease, symptomatic treatment is also important as many severe complications can occur which are either directly related to the pathophysiology of the underlying NS or to the steroid treatment itself. To date, very few studies have been published on the prophylaxis and treatment of these early complications, while recommendations are either lacking or conflicting. This consensus provides indications for the prevention, early recognition and treatment of these complications (management of edema and hypovolemia, therapy and prophylaxis of infections and thromboembolic events). Finally, recommendations about the clinical definition of steroid resistance and its initial diagnostic management, as well as indications for renal biopsy are provided.

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Section: Corticosteroid Use For the First Episode Of Insmentioning

confidence: 99%

The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I - Diagnosis and treatment of the first episode and the first relapse

et al. 2017

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“…However, not all patients show positive response to the therapy and approximately 10-20% of patients don't respond to it. The variety of reactions to this therapy divides the patients to steroid sensitive (SS) and steroid resistant (SR) (Mehls & Hoyer, 2011;Abid et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

“…Actions of glucocorticoids (GCs) include the genomic and nongenomic mechanisms. Genomic reactions of GCs are associated with glucocorticoid receptor α (GR) (Gross et al, 2009;Mehls & Hoyer, 2011). Nongenomic mechanisms include interactions of GCs with cell membrane, cytosolic GR and with cell membrane-bound GR (Smoak & Cidlowski, 2004;Stahn & Buttgereit, 2008;Alangari, 2010).…”

Section: Introductionmentioning

confidence: 99%

Polymorphic variants of MIF gene and prognosis in steroid therapy in children with idiopathic nephrotic syndrome.

et al. 2014

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Nephrotic syndrome (NS) is the most common reason of proteinuria in children and can be caused by the pathology of renal glomeruli. Steroid therapy is typically used in this disorder. It has been shown that MIF is a cytokine which counteracts the immunosuppressive properties of glucocorticoids. The aim of this study was looking for a correlation between MIF polymorphisms and genetic susceptibility to steroid resistance in children with INS (Idiopathic NS). Methods: The study was performed in 71 patients with INS including SRNS (steroid resistance nephrotic syndrome) (41) and SSNS (steroid sensitive nephrotic syndrome) (30) and in 30 control subjects. We employed Sanger sequencing and capillary electrophoresis. Linkage disequilibrium was made using Haploview and PHASE. Results: We didn't observe a statistical significance between SNPs detected in patients with INS and controls. Our studies revealed statistical significance for two polymorphisms: rs2070767C>T and rs2000466T>G between patients with SRNS and SSNS. The results for rs34383331T>A are close to being statistically significant. Statistical significance was revealed for CATT5/CATT6 genotype in SRNS group vs SSNS group (OR=4.604, 95%CI=1.356-15.632, p=0.0168). We found that the frequency of 5/X-CATT genotype compared with X/X-CATT genotype was significantly higher in SRNS patients vs SSNS (OR=3.167, 95%CI=1.046-9.585, p=0.0426). In linkage disequilibrium analysis we didn't show involvement in susceptibility to INS and steroid sensitive phenotype. Conclusions: Our results suggest that the role of MIF polymorphisms in the susceptibility to positive response to steroid therapy is still unresolved. It indicates that MIF may be involved in indirect and complex molecular mechanisms of steroid activity in hormone-dependent metabolic pathways in children with INS. Because of ambiguous findings, pleiotropic features of this cytokine require that more research should be undertaken.

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“…Although the limitations of these findings were described, such as the overriding effect of age or short observation period [2], the hypothesis that BW-based dosing would result in altered treatment outcomes is very interesting. To investigate whether the two dosing regimens might not be equivalent, we therefore retrospectively reviewed the medical records of children diagnosed with idiopathic NS at our institution.…”

mentioning

confidence: 99%

Two dosing regimens for steroid therapy in nephrotic syndrome

Hirano

Fujinaga

2013

Pediatr Nephrol

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Dear Editor, We read with great interest the article entitled "Weight or body surface area dosing of steroids in nephritic syndrome: is there an outcome difference?" by Saadeh et al. which was recently published in Pediatric Nephrology [1].In this article, the authors concluded that dosing of steroids per body surface area (BSA-based dosing) is superior to dosing per kilogram body weight (BW-based dosing) in terms of reducing the frequently relapsing course rate in nephritic syndrome (NS) patients. Although the limitations of these findings were described, such as the overriding effect of age or short observation period [2], the hypothesis that BW-based dosing would result in altered treatment outcomes is very interesting. To investigate whether the two dosing regimens might not be equivalent, we therefore retrospectively reviewed the medical records of children diagnosed with idiopathic NS at our institution.Forty-six consecutive children (36 boys, 10 girls) with newly diagnosed idiopathic NS observed for more than 24 months in Saitama Children's Medical Center from January 2000 to January 2010 were enrolled in the study; patients with steroid-resistant NS at onset or a BW of >30 kg were excluded. Of the 46 patients, 16 (35 %) had received steroid therapy based on BSA, while the remaining 30 (65 %) had received steroid therapy based on BW. The choice of dosing regimen depended on the treating physician. The age of the children at onset varied from 1.0 to 11.4 (median 4.0) years.Although there were no significant differences between the two groups in terms of gender ratio, age, serum albumin at onset, time to response to initial therapy, or proportion of adverse events, the onset time for relapses after initial therapy was significantly shorter for children in the BW-based dosing group than for those in the BSA-based group (2.0 vs. 6.0 months; p<0.05). Further, the proportion of steroiddependent NS was also significantly higher among children in the BW-based dosing group than among those in the BSA-based group (53.3 vs. 12.5 %; p<0.05).Our study, although retrospective in nature, indicates that for children with idiopathic NS, BW-based and BSA-based steroid dosing are not equivalent if the child's BW is <30 kg.In conclusion, our findings are in agreement with the simulation study by Saadeh et al.[1] that BW-based dosing might lead to "underdosing." Based on our retrospective analysis, we would like comment that in order to enable accurate comparisons between trials, consistent dosing regimens should be used in future trials involving children with idiopathic NS. References

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Dosing of glucocorticosteroids in nephrotic syndrome

Cited by 14 publications

References 26 publications

The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I - Diagnosis and treatment of the first episode and the first relapse

The Italian Society for Pediatric Nephrology (SINePe) consensus document on the management of nephrotic syndrome in children: Part I - Diagnosis and treatment of the first episode and the first relapse

Polymorphic variants of MIF gene and prognosis in steroid therapy in children with idiopathic nephrotic syndrome.

Two dosing regimens for steroid therapy in nephrotic syndrome

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