Intermittent versus long-term tapering prednisolone for initial therapy in children with idiopathic nephrotic syndrome

Ueda, Norishi; Chihara, Masaru; Kawaguchi, Shinji; Niinomi, Yukihiko; Nonoda, T; Matsumoto, Junko; Ohnishi, Masazumi; Yasaki, Takehiko

doi:10.1016/s0022-3476(88)80136-7

Cited by 80 publications

(46 citation statements)

References 7 publications

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“…25 Longer initial steroid induction regime of ISKDC proposed and studied by Ueda et al and Ksiazek & Wysznska, who showed a two-year relapse free rate of 50% for the long initial steroid dose versus 27.3% for the modified ISKDC regime. 17,18 Despite that no additional benefit was demonstrated in 12 months treatment, compared with five months. 25 Another point of view is that, in the consideration of shorter timed corticosteroid treatment, patient will experience more frequent relapses, he would be given initial doses of corticosteroids again or if high doses of i.v.…”

Section: Discussionmentioning

confidence: 96%

“…27 Recent studies showed reduction of relapse rate (25-30%) with a steroid treatment regimen of three months or more. 17,18,[27][28][29] In addition to these data it is reported that longer treatment duration is more important than the cumulative dose of steroids in reducing the risk of relapse. 30 This finding was supported with a meta-analysis study.…”

Section: Discussionmentioning

confidence: 99%

“…16 Although previous data reported better prognosis with the long-term treatment, there were any clear consensus about steroid treatment duration. 17,18 Various regimes of corticosteroids have been used. The aim of this study is to report our experience with INS in the long-term steroid treatment.…”

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confidence: 99%

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The long-term outlook to final outcome and steroid treatment results in children with idiopathic nephrotic syndrome

et al. 2015

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Idiopathic Nephrotic Syndrome (INS) was defined as combination of a nephrotic syndrome and non-specific histological abnormalities of the kidney. Among these abnormalities, minimal change nephrotic syndrome (MCNS) is the most common. We report our experience with MCNS; its clinical course, treatments and outcomes. One-hundred twenty children (66 male, 54 female) with MCNS, admitted to Nephrology Department between 1987-2009 was assessed. Their clinical presentations, treatment and disease courses were reviewed. The mean duration of follow-up was 11.5 ± 1.9 years. Initially, all patients given prednisone 2 mg/kg/ day single dose per four weeks a followed by eight weeks of the same daily dose given every other day. After week 12, prednisone was progressively tapered off at the rate of 0.5 mg/kg per 15 daily intervals until complete discontinuation had been achieved by week 16. Steroid resistance was accepted as no achievement of remission following four weeks of prednisone 2 mg/kg/day followed by three intravenous pulses of corticosteroids. At the end of the initial steroid treatment, 106 (88.3%) patients were determinate steroid responsive while 14 (11.7%) patients were steroid resistance. Thirty-eight patients underwent biopsy. At the end of study recovery rate was increased from 88.3% to 94.1%. In conclusion, most of patients entered remission by our therapy end of follow up time. With the support of our satisfactory results among the whole study group, long-term prednisolone treatment still remains valid.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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The long-term outlook to final outcome and steroid treatment results in children with idiopathic nephrotic syndrome

et al. 2015

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“…In children, data support that slow steroid tapers may lead to less steroid dependence and relapse compared with rapid tapers. The work by Ueda et al 38 studied 46 incident children diagnosed with steroid-sensitive NS after treatment with high-dose steroids (60 mg/m 2 ) for 4 weeks. They were then randomized to either rapid taper (prednisolone=40 mg/m 2 for 3 consecutive days per week for 4 weeks) or slow taper (prednisolone=40 mg/m 2 every other day for 4 weeks followed by a slow taper over 5 months).…”

Section: Duration and Taper Of Steroid Therapymentioning

confidence: 99%

The Treatment of Minimal Change Disease in Adults

Hogan

Radhakrishnan

2013

Journal of the American Society of Nephrology

133

123

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Minimal change disease (MCD) is the etiology of 10%-25% of cases of nephrotic syndrome in adults. The mainstay of treatment for adult MCD, oral gucocorticoids, is based on two randomized controlled trials and extensive observational data in adults, and this treatment leads to remission in over 80% of cases. Relapses are common, and some patients become steroid-resistant (SR), steroid-dependent (SD), or frequently relapsing (FR). The data guiding the treatment of these patients are limited. Here, we review MCD in adults with particular focus on the evidence for immunosuppressive therapy in these patients.

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“…Moreover, a considerable number have frequent relapses and develop corticosteroid toxicities after repeated treatments (1,2). Although some controlled studies (3)(4)(5)(6) and a meta-analysis (7) have shown that long-course corticosteroid regimens result in a longer sustained remission of the disease than the ISKDC regimen, the most appropriate treatment of idiopathic NS has not been determined. There have been no recent large-scale reports of the outcome of the ISKDC regimen in patients with idiopathic NS.…”

Section: Introductionmentioning

confidence: 99%

Two-Year Outcome of the ISKDC Regimen and Frequent-Relapsing Risk in Children with Idiopathic Nephrotic Syndrome

Nakanishi

Iijima

Ishikura

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Early identification of frequently relapsing children with idiopathic nephrotic syndrome is desirable.Design, setting, participants, & measurements The relapse status and clinical data of patients previously registered (January of 1993 to December of 2001) in a multicenter prospective study of the International Study of Kidney Disease in Children regimen were analyzed for risk of frequent relapsers over a 2-year follow-up period.Results Of 166 children with nephrotic syndrome (113 boys and 53 girls; median age=5.1 years), 145 (87.3%, median age=5.5 years) children were steroid-sensitive, and 21 (12.7%, median age=2.9 years) children were steroid-resistant. Of 145 children with steroid-sensitive nephrotic syndrome, 32 (22.1%, median age=4.2 years) children experienced frequent relapses over 2 years. The time to initial response was significantly longer (10 versus 7 days, P,0.001, log-rank test) in the 32 frequent relapsers than in the 106 nonfrequent relapsers. The time from start of initial treatment to first relapse was significantly shorter (2.6 versus 6.1 months, P,0.001, log-rank test) in the 32 frequent relapsers than in the 57 infrequent relapsers. In a Cox regression model, the time to initial response $9 days and the duration from start of initial treatment to first relapse ,6 months were significant predictors of frequent relapses (unadjusted and adjusted).Conclusions Initial remission time $9 days and first relapse within 6 months were associated with frequent relapses. These findings may also be useful also in selecting potential frequent relapsers for clinical trials.

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Intermittent versus long-term tapering prednisolone for initial therapy in children with idiopathic nephrotic syndrome

Cited by 80 publications

References 7 publications

The long-term outlook to final outcome and steroid treatment results in children with idiopathic nephrotic syndrome

The long-term outlook to final outcome and steroid treatment results in children with idiopathic nephrotic syndrome

The Treatment of Minimal Change Disease in Adults

Two-Year Outcome of the ISKDC Regimen and Frequent-Relapsing Risk in Children with Idiopathic Nephrotic Syndrome

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