Prolonged versus standard prednisolone therapy for initial episode of idiopathic nephrotic syndrome.

Background: The prolongation of steroid therapy for an initial episode of idiopathic nephrotic syndrome may decrease any relapses. Two treatment protocols were compared with the objective of finding the frequency of relapses and side effects of steroid in the following 12-month period.

Methods: A hospital-based prospective study was conducted of 80 children allocated randomly to receive prolonged (5-month) or standard (3-month) prednisolone therapy. They were followed quarterly for 12 months during which the numbers of relapses and steroid side effects were noted.

Results: The mean relapse rate (0.63 vs. 1.54; p=0.011) and cumulative risk of relapse per patient per month (0.05 vs. 0.131) were significantly lower in the prolonged than the standard treatment. Total relapses in patients followed up for 12 months were significantly lower in the prolonged-therapy as compared with the standard-therapy group (21.6% vs. 70.2%; p=0.001). Cumulative percentage of patients with sustained remission at 12 months was significantly higher in the prolonged-therapy than the standard-therapy group (76% vs. 29%). Mean cumulative dose of prednisolone with prolonged therapy was significantly lower than with standard treatment (p=0.033). Steroid side effects such as cushingoid appearance, hirsutism, striae and hypertension were comparable in both treatment groups.

Conclusions: A prolonged course of prednisolone therapy for an initial episode of nephrotic syndrome can be considered, as it reduces the rate of relapses without increasing the risk for steroid side effects.