Short Course of Daily Prednisolone During Upper Respiratory Tract Infection for Children With Relapsing Steroid Sensitive Nephrotic Syndrome

Mathew, Joseph L; Bagga, Arvind; Sinha, Aditi; Sinha, Rajiv; Sankar, Janani

doi:10.1007/s13312-022-2499-0

Cited by 4 publications

(3 citation statements)

References 2 publications

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“…18,19 This has been recently refuted by the PREDNOS 2 trial done in the United Kingdom, 20 but some reviewers have attributed the difference in outcome to a different environmental and genetic makeup of PREDNOS 2 cohort in comparison with previous South Asian studies. 21 We acknowledge the limitation of our study. Financial and logistic limitations meant that we were not able to conduct a multicenter double-blind placebo-controlled RCT.…”

Section: Discussionmentioning

confidence: 88%

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Single vs. Divided-Dose Prednisolone for the First Episode of Nephrotic Syndrome in Children

Khan

Akhtar

Mukherjee

et al. 2023

CJASN

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Background: Early morning single dose prednisolone has hypothetical advantage of less hypothalamic-pituitary-adrenal axis (HPA) suppression, but lack of robust evidence has resulted in variation in practice with divided dose prednisolone still commonly used. We conducted this open label randomized control trial to compare HPA axis suppression between single or divided dose prednisolone among children with first episode nephrotic syndrome. Methods: Sixty children with first episode nephrotic syndrome were randomized (1:1) to receive prednisolone (2 mg/kg per day), either as single or two divided dose for 6 weeks, followed by single alternative daily dose of 1.5 mg/kg for 6 weeks. Short Synacthen Test (SST) was conducted at 6 weeks with HPA suppression defined as post adrenocortopric hormone (ACTH) cortisol <18 µmg/dl. Results: Four children (single=1 and divided dose=3) did not attend SST and were hence excluded from analysis. Remission was induced in all and no relapse post remission was noted during the 6+6 weeks steroid therapy. After 6 weeks of daily steroids, HPA suppression was greater in divided (100%) vs single dose (83%) (p =0.02). Time to remission and final relapse rate were similar, but for those children who relapsed within 6 months of follow up period time to first relapse was shorter for divided dosing (median 28 vs 131 days) p=0.002. Conclusions: Among children with first episode nephrotic syndrome, single and or divided dose prednisolone were equally effective in inducing remission with similar relapse rates, but single dose had less HPA suppression and longer time to first relapse.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Single vs. Divided-Dose Prednisolone for the First Episode of Nephrotic Syndrome in Children

Khan

Akhtar

Mukherjee

et al. 2023

CJASN

Self Cite

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“…In the case of upper respiratory tract infections (URTIs), 0.5 kg/day of prednisolone is prescribed during maintenance treatment, or no treatment is considered for up to ve days. The symptoms of URTIs (fever above 38°C, runny nose, cough, myalgia, fatigue, anorexia, and sore throat) were explained to the parents of the patients and they were advised to call the center whenever the symptoms occurred [10,11].…”

Section: Treatment and Follow Upmentioning

confidence: 99%

Levothyroxine therapy in children with hypothyroidism due to frequently relapsing nephrotic syndrome: an observational cohort study

Saberinejad,

Taheri,

Dormanesh

et al. 2023

Preprint

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Background: Although the prevalence of temporary hypothyroidism (HT) in nephrotic syndrome (NS) is high, there is conflict over hormone replacement therapy in these cases. In an observational cohort with a control group, we investigated the potential benefits of hormone replacement therapy in patients with frequently relapsing nephrotic syndrome (FRNS) and HT. Methods: Consecutive 2–13-year-old patients with FRNS and thyroid stimulant hormone (TSH) higher than 5.5 mIU/L were studied. Following relapse treatment, patients treated with levothyroxine were considered the levothyroxine group. The incidence of relapses was the primary outcome. Secondary outcomes were the cumulative dose of prednisolone, the number of treatment failures, and the duration of each relapse. Results: Thirty-two relapses per 27.2 person-years and 45 per 29.2 person-years occurred in the levothyroxine and control groups, respectively. The relapse rate was 1.17 versus 1.53 with the incidence rate ratio of 0.76 (95%Cl: 0.46- 1.22; p=0.24). The mean dose of prednisolone and time to remission was significantly lower in the levothyroxine group compared to the controls (0.51 ± 0.40 versus 0.55 ± 0.50 mg/kg/day; p=0.03 and 6.0 ± 2.17 versus 9.7 ± 2.87 days; p<0.001, respectively). There was a significant difference in the levels of TSH, free thyroxine (FT4), albumin, and creatinine. This significant difference disappeared during remission for albumin but remained significant for TSH and creatinine. Conclusion: In patients with FRNS, the administration of levothyroxine can reduce the time to remission and dose of prednisolone. However, it has no significant effect on relapse rate and treatment failure.

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A Retrospective Study of Children with Frequently Relapsing Nephrotic Syndrome Using Levothyroxine Added to Steroids During Relapses

Saberinejad,

Taheri,

Dormanesh

et al. 2024

Preprint

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Introduction: Levothyroxine treatment for thyroid hormone disorders, alongside standard Nephrotic Syndrome therapy during nephrotic syndrom relapses, might reduce relapse duration and corticosteroid consumption, despite debates over its necessity. This study explores levothyroxine's potential benefits in patients with frequent relapses and thyroid hormone disorders. Materials and Methods: This retrospective study investigated children with frequently relapsing nephrotic syndrome (FRNS) at ages 1–12 with elevated TSH levels, which have been treated according to IPNA guidelines for FRNS. Patients treated with levothyroxine were considered the levothyroxine group. This study compared outcomes between patients treated with levothyroxine and a control group, examining TSH levels, remission periods, and prognosis. Results: The mean dose of prednisolone and time to remission were significantly lower in the levothyroxine group compared to the controls (0.51 ± 0.40 versus 0.55 ± 0.50 mg/kg/day; p=0.03 and 6.0 ± 2.17 versus 9.7 ± 2.87 days; p<0.001, respectively). The relapse rate was 1.17 versus 1.53 with an incidence rate ratio of 0.76 (95% CL: 0.46–1.22; p = 0.24). There was a significant difference in the levels of TSH, free thyroxine (FT4), albumin, and creatinine. This significant difference disappeared during remission for albumin but remained significant for TSH and creatinine. Conclusion: This study suggests that administering levothyroxine during relapses can reduce the time to remission and, consequently, the cumulative dose of prednisolone. However, it does not significantly affect the prevention of future relapses, treatment failure, or steroid toxicity.

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Short Course of Daily Prednisolone During Upper Respiratory Tract Infection for Children With Relapsing Steroid Sensitive Nephrotic Syndrome

Cited by 4 publications

References 2 publications

Single vs. Divided-Dose Prednisolone for the First Episode of Nephrotic Syndrome in Children

Single vs. Divided-Dose Prednisolone for the First Episode of Nephrotic Syndrome in Children

Levothyroxine therapy in children with hypothyroidism due to frequently relapsing nephrotic syndrome: an observational cohort study

A Retrospective Study of Children with Frequently Relapsing Nephrotic Syndrome Using Levothyroxine Added to Steroids During Relapses

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