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Increasing the dose of Prednisolone during viral infections reduces the risk of relapse in Nephrotic Syndrome: a randomised controlled trial
  1. Asiri S Abeyagunawardena (asiri26{at}hotmail.com)
  1. Department of Paediatrics, University of Peradeniya, Sri Lanka
    1. Richard S Trompeter (trompr{at}gosh.nhs.uk)
    1. Great Ormond Street Children's Hospital, United Kingdom

      Abstract

      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
      • proteinuria
      • relapse
      • viral infections

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