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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}
  1. Department of Paediatrics, University of Peradeniya, Sri Lanka
    1. Richard S Trompeter (trompr{at}
    1. Great Ormond Street Children's Hospital, United Kingdom


      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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