Relapse of nephrotic syndrome (NS) are frequently triggered by viral upper respiratory tract infections (URTI’s), possibly mediated by cytokine release. The hypothesis that a small and short term increase in the dose of prednisolone will reduce the release of cytokines and thereby reduce the risk of relapse was tested by a randomised double blind placebo controlled cross over trial.
Sequential patients receiving low dose (<0.6mg/kg) prednisolone on alternate day as maintenance therapy were recruited. At the first sign of a presumed viral URTI, all children were examined and randomly allocated to take medicine A or B (containing either prednisolone (5mg) or placebo tablets) with the first viral URTI and vice versa with the second. If criteria to diagnose a viral URTI were met, the new medicine was prescribed on alternate day for one week at the same dosage the patient was taking prednisolone on an alternate day basis. A freshly voided urine sample was tested each morning and presence of 3 + proteinuria for three consecutive days was diagnostic of relapse.
48 patients were recruited and 40 completed the trial. 29 male ; 11 female. Age at entry ranged from 1.5 to 13.2 (median 5.3) years. The relapse rate following viral URTI was 19/40 (47.5%) in the placebo group and 7/40 (17.5%) relapses in the prednisolone group. p = 0.014 (2 sided probability using Fisher’s Exact Test).
Prescribing prednisolone daily for 7 consecutive days at the same dose that a patient is receiving on an alternate day basis at the onset of a presumed viral URTI, significantly reduces the risk of relapse in children with steroid dependant NS.
- Nephrotic Syndrome
- glucocorticoid therapy
- viral infections