Corticosteroid therapy in nephrotic syndrome: a meta-analysis of randomised controlled trials

Hodson, EM

doi:10.1136/adc.83.1.45

Cited by 76 publications

(58 citation statements)

References 18 publications

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“…Pemberian kortikosteroid menurunkan angka kematian dari 35% menjadi 3%. 8 Pemberian kortikosteroid dengan dosis tepat sesuai berat badan kering anak penting dalam menangani anak penderita SN karena toksisitas pemberian kortikosteroid berpotensi mengancam hidup sehingga risiko dan manfaat terapi harus terus dievaluasi.…”

Section: Pendahuluanunclassified

Korelasi Kadar Albumin Serum dengan Persentase Edema pada Anak Penderita Sindrom Nefrotik dalam Serangan

Novina¹,

Gurnida²,

Sekarwana³

2015

mkb

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AbstrakSindrom nefrotik (SN) merupakan kelainan glomerulus yang ditandai proteinuria masif, hipoalbuminemia, edema, dan hiperlipidemia. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar albumin serum dan persentase edema pada anak penderita SN dalam serangan. Suatu uji analitik korelasional rancangan crosssectional dilakukan selama bulan Agustus 2009 sampai Januari 2010. Subjek penelitian adalah anak penderita SN dalam serangan, usia 1-14 tahun, berobat ke poliklinik atau dirawat di Rumah Sakit Dr. Hasan Sadikin dan RS Jejaring (RSU Cibabat dan RSU Ujung Berung). Persentase edema dihitung dengan mengurangi total body water (TBW) anak saat sakit dengan TBW ideal, kemudian hasilnya dipersentasekan dengan TBW ideal. Analisis statistik menggunakan Uji korelasi Spearman. Pada penelitian ini didapatkan 29 subjek terdiri atas 26 laki-laki dan 3 perempuan. Kadar albumin serum rata-rata 1,45 g/dL dan persentase edema 21,6%. Hasil Uji korelasi Spearman menunjukkan hubungan yang sangat bermakna (p=0,006) antara kadar albumin serum dan persentase edema (r=-0,501). Simpulan, terdapat hubungan negatif antara kadar albumin serum dan persentase edema pada anak penderita SN dalam serangan. [MKB. 2015;47(1):55-9] Kata kunci: Kadar albumin serum, persentase edema, sindrom nefrotik dalam serangan Correlation Between Serum Albumin Levels and Percentage of Edema during Nephrotic Stage in Children with Nephrotic Syndrome AbstractNephrotic syndrome (NS) is a glomerular disorder characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. The aim of this study was to evaluate the correlation between serum albumin levels and percentage of edema during nephrotic stage in children with NS. Cross-sectional design with correlational analytic was used in this study. The subjects of this study were outpatients and inpatients with NS during nephrotic stage, aged between 1 and 14 years old, admitted to Dr. Hasan Sadikin General Hospital Bandung, Cibabat Hospital, and Ujung Berung Hospital from August 2009 to January 2010. Percentage of edema was calculated by substracting total body water (TBW) during illness to ideal TBW, then divided the result by ideal TBW. Subjects were 29 children, consisted of 26 boys and 3 girls. Mean serum albumin levels was 1.45 g/dL and percentage of edema was 21.6%. Analysis using Spearman correlation test showed a highly significant correlation (p=0.006) between serum albumin levels and percentage of edema in children with NS during nephrotic stage (r=-0.501).In conclusion, there is a negative correlation between serum albumin levels and percentage of edema during nephrotic stage in children with NS. [MKB. 2015;47(1):55-9]

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Section: Pendahuluanunclassified

Korelasi Kadar Albumin Serum dengan Persentase Edema pada Anak Penderita Sindrom Nefrotik dalam Serangan

Novina¹,

Gurnida²,

Sekarwana³

2015

mkb

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“…In 2000 we published a systematic review of RCTs which evaluated corticosteroid therapy in children with their first episode of steroid-sensitive nephrotic syndrome (SSNS) [3]. In a meta-analysis of five RCTs (334 children), prednisolone administered for 3-7 months compared with 2 months in the initial episode of SSNS significantly reduced the risk of relapse at 12-24 months by 27 % [relative risk (RR) 0.73; 95 % confidence intervals (CI) 0.60-0.89) and reduced the number of children with frequently-relapsing nephrotic syndrome (FRNS) by 33 % (RR 0.67; 95 % CI 0.48-0.93).…”

Section: Combining the Evidence From Rctsmentioning

confidence: 99%

“…Thus, the heterogeneity among the studies can be explained by differences in methodological quality (risk of bias). The studies included in the systematic review published in 2000 [3] and in the updates to 2007 [4] were generally of high or unclear risk of bias. Only three studies showed adequate allocation concealment [12][13][14], and no studies were blinded.…”

Section: Investigation Of Heterogeneity In Meta-analysesmentioning

confidence: 99%

Corticosteroids for the initial episode of steroid-sensitive nephrotic syndrome

2015

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“…Research by Norero et al in 1996 which compared the ISKDC regimen with a 12 week prednisolone regimen also yielded similar results 22 . The meta-analysis by Hodson E, et al suggested that extension of alternate day steroid by one month reduces the risk of relapse at 2 years by 7% up to 7 months 3 . The Cochrane Database Systematic Review of 2015 suggests that there are many factors that determine the risk of relapse viz.…”

Section: Methodsmentioning

confidence: 99%

“…Nephrotic syndrome has an incidence of 2 to 7 per 100,000 Caucasian children with a higher incidence of about 16 per 100,000 in Asian children 2,3 . Steroid-sensitive NS remains the predominant type of NS during childhood with 90-95% children being responsive to steroids, of whom a greater proportion have minimal change nephropathy (MCN) 4 .…”

Section: Introductionmentioning

confidence: 99%

Long-term tapering regimen of prednisolone for the initial episode of nephrotic syndrome

Thalgahagoda

Karunadasa

Kudagammana

et al. 2017

Sri Lanka J Child Health

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Background: Childhood nephrotic syndrome (NS) has a relapsing-remitting course resulting in a significant corticosteroid burden or a prescription of cytotoxic immunosuppressive therapy. The ideal steroid regimen for the initial episode remains elusive.Objective: This study was conducted at a single centre to assess the outcome of a longer regimen of prednisolone for the initial episode of childhood NS in comparison to the shorter regimen used earlier. Methods:The clinical records of children with NS were stored manually since 1994 and electronically since 2002. From 1994 to 2002 all patients attending with the initial episode of NS were prescribed 60mg/m 2 prednisolone for 4 weeks followed by 40mg/m 2 on alternate days for 4 weeks (short term therapy / ST). From 2002 the initial episode was treated with 60mg/m 2 prednisolone for 4 weeks, followed by 60mg/m 2 on alternate days for 2 weeks tapering by 10mg/m 2 every 2 weeks over a period of 12 weeks (long term therapy / LT). The outcome of patients treated with ST over a period of 8 years was compared with patients treated with LT for 8 years.Results: Fifty eight children were treated with ST and 112 with LT. The relapse rate with LT was 12.4% at 6 months, 30.5% at 12 months and 48% at 24 months of the study compared to the 31.5% at 6 months 61% at 12 months and 81% at 24 months for ST. The mean time period for the first relapse to occur was 22.8 months for LT, whereas this was 12.5 months for ST. Conclusion:A long term tapering regimen is superior in maintaining sustained remission compared to short term therapy for the first episode of childhood NS. _________________________________________

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Corticosteroid therapy in nephrotic syndrome: a meta-analysis of randomised controlled trials

Abstract: Conclusions-Children in their first episode of steroid responsive nephrotic syndrome should be treated with prednisone for at least three months, with an increase in benefit being shown for up to seven months of treatment. (Arch Dis Child 2000;83:45-51)

Cited by 76 publications

References 18 publications

Korelasi Kadar Albumin Serum dengan Persentase Edema pada Anak Penderita Sindrom Nefrotik dalam Serangan

Korelasi Kadar Albumin Serum dengan Persentase Edema pada Anak Penderita Sindrom Nefrotik dalam Serangan

Corticosteroids for the initial episode of steroid-sensitive nephrotic syndrome

Long-term tapering regimen of prednisolone for the initial episode of nephrotic syndrome

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