Short courses of daily prednisolone during upper respiratory tract infections reduce relapse frequency in childhood nephrotic syndrome

Abstract

Background -Relapses of childhood nephrotic syndrome (NS) are frequently precipitated by viral

Steroid Sensitive Nephrotic Syndrome: Revised Guidelines

“…to daily administration of prednisolone for 5-7 days prevents the occurrence of relapses. One cross-over trial also supports the use of low-dose daily prednisolone in preventing infection-associated relapses in patients off corticosteroids [59]. Results of the PREDNOS2 trial will clarify the role of these strategies in preventing infectionassociated relapses (ISRCTN10900733).…”

Nephrotic syndrome in adults: symptoms and management

“…Several trials suggest that relapses might be reduced if corticosteroids are administered daily for five to seven days at the onset of upper respiratory tract infection in children with FRNS or SDNS who are either not currently taking corticosteroids or taking alternate-day corticosteroids. In the most recent 2017 study by Abeyagunawardena et al, 48 patients with SDNS (but off prednisone for at least three months) were randomized to receive either five days of daily prednisolone at 0.5 mg/kg at the onset of an upper respiratory tract infection or five days of placebo 209 A minority (34.4%) of the treatment group relapsed, whereas 40.6% of the control group experienced a single relapse, and 18.8% had two relapses. These short courses of preemptive corticosteroid treatment may avert the need for longer courses of corticosteroids, therefore reducing toxicity.…”

“…There is low quality in the evidence for RCTs examining the use of daily and increased dose prednisolone in patients on maintenance therapy with alternate-day prednisolone during viral infections (Table S14 191,[209][210][211][212] ). Relapse and rate of infection-related relapse were the only critical and important outcomes examined in these studies.…”

“…Abeyagunawardena 2017 is a cross-over study that has not reported sufficient data to be included in a paired analysis; therefore, no PICO table has been presented. 209 Abeyagunawardena 2017 was downgraded due to a 31% attrition for patients not completing both parts of the cross-over study, and serious imprecision as it is the only trial that examined prednisone versus placebo in children with SSNS after three months off prednisone therapy.…”

Managing a child with nephrotic syndrome

“…Several studies have demonstrated a reduction in relapse rate by a slight, short term increase in the prednisolone dose at the commencement of an URTI in patients with SDNS who were on EOD corticosteroids 13,14,15 . Another study recently demonstrated that a 5 day course of prednisolone prescribed at 0.5mg/kg/day during URTI is capable of reducing the relapse frequency in patients who are off steroids 16 . Based on these findings we make the following recommendations.…”