Short-Duration Prednisolone in Children with Nephrotic Syndrome Relapse

Kainth, Deepika; Hari, Pankaj; Sinha, Aditi; Pandey, Shivam; Bagga, Arvind

doi:10.2215/cjn.06140420

Cited by 16 publications

(7 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The second study instead attempted to establish the noninferiority of employing a lower oral prednisone dose by comparing 40 mg/m 2 on alternate days for 4 weeks versus 40 mg/m 2 on alternate days for 2 weeks in children with infrequently relapsing nephrotic syndrome. 241 The rate of relapse was similar in the 2 groups of children. However, noninferiority of the short regimen was not established in this study.…”

Section: Rationalementioning

confidence: 75%

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

Rovin¹,

Adler²,

Barratt³

et al. 2021

Kidney International

1,214

883

View full text Add to dashboard Cite

S28 Introduction S30 Summary of recommendation statements and practice points S88 Chapter 1: General principles for the management of glomerular disease S115 Chapter 2: Immunoglobulin A nephropathy (IgAN)/immunoglobulin A vasculitis (IgAV) S128 Chapter 3: Membranous nephropathy S140 Chapter 4: Nephrotic syndrome in children S153 Chapter 5: Minimal change disease (MCD) in adults S161 Chapter 6: Focal segmental glomerulosclerosis (FSGS) in adults S172 Chapter 7: Infection-related glomerulonephritis S187 Chapter 8: Immunoglobulin-and complement-mediated glomerular diseases with a membranoproliferative glomerulonephritis (MPGN) pattern of injury S193 Chapter 9: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis S207 Chapter 10: Lupus nephritis S231 Chapter 11: Anti-glomerular basement membrane (Anti-GBM) antibody glomerulonephritis S235 Methods for guideline development S243 Biographic and disclosure information S254 Acknowledgments S256 ReferencesThis guideline is published as a supplement supported by KDIGO. The development and publication of this guideline are strictly funded by KDIGO, and neither KDIGO nor its guideline Work Group members sought or received monies or fees from corporate or commercial entities in connection with this work. The opinions or views expressed in this professional education supplement are those of the authors and do not necessarily reflect the opinions or recommendations of the International Society of Nephrology or Elsevier. Dosages, indications, and methods of use for products that are referred to in the supplement by the authors may reflect their clinical experience or may be derived from the professional literature or other clinical sources. Because of the differences between in vitro and in vivo systems and between laboratory animal models and clinical data in humans, in vitro and animal data may not necessarily correlate with clinical results.

show abstract

Section: Rationalementioning

confidence: 75%

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

Rovin¹,

Adler²,

Barratt³

et al. 2021

Kidney International

1,214

883

View full text Add to dashboard Cite

show abstract

“…Children with uncomplicated, infrequent relapses are treated with daily PDN, 60 mg/m 2 until complete remission followed by conversion to a reduced dose (40 mg/m 2 per dose) on alternate days for 4 weeks [ 78 ] (see Supplementary Table S3.3 ). A single RCT assessed whether reducing the duration of alternate day PDN relapse therapy to 2 weeks after remission is non-inferior to the standard 4-week duration [ 79 ]. The time to first relapse, development of FRNS or SDNS, and adverse effects were similar in both groups.…”

Section: First Line Therapy Of Relapsing Ssnsmentioning

confidence: 99%

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

Trautmann

Boyer²,

Hodson³

et al. 2022

Pediatr Nephrol

View full text Add to dashboard Cite

Idiopathic nephrotic syndrome is the most frequent pediatric glomerular disease, affecting from 1.15 to 16.9 per 100,000 children per year globally. It is characterized by massive proteinuria, hypoalbuminemia, and/or concomitant edema. Approximately 85–90% of patients attain complete remission of proteinuria within 4–6 weeks of treatment with glucocorticoids, and therefore, have steroid-sensitive nephrotic syndrome (SSNS). Among those patients who are steroid sensitive, 70–80% will have at least one relapse during follow-up, and up to 50% of these patients will experience frequent relapses or become dependent on glucocorticoids to maintain remission. The dose and duration of steroid treatment to prolong time between relapses remains a subject of much debate, and patients continue to experience a high prevalence of steroid-related morbidity. Various steroid-sparing immunosuppressive drugs have been used in clinical practice; however, there is marked practice variation in the selection of these drugs and timing of their introduction during the course of the disease. Therefore, international evidence-based clinical practice recommendations (CPRs) are needed to guide clinical practice and reduce practice variation. The International Pediatric Nephrology Association (IPNA) convened a team of experts including pediatric nephrologists, an adult nephrologist, and a patient representative to develop comprehensive CPRs on the diagnosis and management of SSNS in children. After performing a systematic literature review on 12 clinically relevant PICO (Patient or Population covered, Intervention, Comparator, Outcome) questions, recommendations were formulated and formally graded at several virtual consensus meetings. New definitions for treatment outcomes to help guide change of therapy and recommendations for important research questions are given.

show abstract

“…Optimal duration of taper schedules is unknown and studies addressing the use of long-term alternate-day corticosteroid therapy to maintain remission are lacking. Kainth et al (21) recently published a randomized clinical trial reporting on the efficacy of prednisolone as a "short regimen" (40 mg/m 2 on alternate days for 2 weeks) compared with "standard regimen" (40 mg/m 2 on alternate days for 4 weeks) for children with infrequent relapses of nephrotic syndrome. They observed that a similar proportion of patients developed a frequently-relapsing or steroid-dependent course, suggesting no benefit from using longer courses.…”

Section: Discussionmentioning

confidence: 99%

Characteristics Associated with Variation in Corticosteroid Exposure in Children with Steroid-Sensitive Nephrotic Syndrome: Results from a Canadian Longitudinal Study

et al. 2021

View full text Add to dashboard Cite

Background: Variation in dose and duration of corticosteroids for childhood-onset steroid-sensitive nephrotic syndrome occurs worldwide, likely reflecting the evolving evidence on optimal dosing and variable severity of the disease observed between patients. We conducted a study to determine the associations between site, physician, and patient factors and average daily corticosteroid dose and duration of therapy. Methods: Data were derived from the Canadian Childhood Nephrotic Syndrome (CHILDNEPH) Project, an observational longitudinal study from 2013 to 2019 of children with nephrotic syndrome involving pediatric nephrologists in 11 sites across Canada. Primary outcome was average daily corticosteroid dose prescribed per episode of proteinuria, reported as mg/m2 prednisone equivalents. Secondary outcome was duration of treatment for each episode of proteinuria in days. Exposure variables were categorized into site-, physician- and patient-level variables. Results: 328 children, median age at enrollment of 4.3 years old (Interquartile range [IQR]: 3.6), participated and were followed for a median time of 2.62 years (IQR: 2.61). The observed variability in average daily corticosteroid dose and in duration of therapy was mostly attributed to the site where the patient was treated. Accounting for between patient, physician and site differences, average daily corticosteroid dose decreased with increasing age (beta coefficient: -0.07 [95% Confidence interval (CI) -0.09, -0.05], p<0.001). African and Indigenous ethnicity was associated with longer treatment duration compared to Caucasian (beta coefficient: African 42.29 [95% CI 7.85, 76.73 p=0.016], Indigenous 29.65 [95% CI 2.79, 56.52 p=0.03]). Conclusions: We found practice variation with respect to corticosteroid prescriptions across 11 Canadian sites, and that variation is mostly explained at the site level. Age and ethnicity are important factors to be considered, as they are significantly associated with average corticosteroid dose and duration of therapy.

show abstract

Short-Duration Prednisolone in Children with Nephrotic Syndrome Relapse

Cited by 16 publications

References 15 publications

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

IPNA clinical practice recommendations for the diagnosis and management of children with steroid-sensitive nephrotic syndrome

Characteristics Associated with Variation in Corticosteroid Exposure in Children with Steroid-Sensitive Nephrotic Syndrome: Results from a Canadian Longitudinal Study

Contact Info

Product

Resources

About