OUTCOME OF SHORT AND LONG DURATION STEROID THERAPY IN CHILDHOOD NEPHROTIC SYNDROME IN TERMS OF FREQUENCY OF RELAPSE RATE

Authors

  • Abdul Ahad Jamshaid Children’s Hospital, Lahore-Pakistan
  • Naureen Akhtar Children’s Hospital, Lahore
  • Aneeqa Adnan Children’s Hospital, Lahore
  • Shahida Perveen Children’s Hospital, Lahore
  • Adeela Chaudhry Children’s Hospital, Lahore
  • Tehreem Tatima Children’s Hospital, Lahore

DOI:

https://doi.org/10.55519/JAMC-02-9324

Keywords:

Steroid sensitive, Nephrotic syndrome, relapse, steroids

Abstract

Background: Nephrotic syndrome is a clinical syndrome defined by massive proteinuria (greater than 40 mg/m2/hour) responsible for hypoalbuminemia (less than 30 g/L) resulting in oedema and hyperlipidaemia. Objective of the study was to compare the frequency of relapse rate with short and long duration steroid therapy in Nephrotic syndrome. It was a Quasi-experimental control group design, conducted at the Department of Paediatric Nephrology, The Children’s Hospital and Institute of Child Health, Lahore. Duration of study: One year. Method: The data of 150 patients with steroid sensitive nephrotic syndrome was included with clinical presentation and diagnostic investigations. The children were randomly divided into long and short duration steroid treatment groups. Outcome was determined in terms of relapse rate after achieving remission with both treatment strategies. Independent sample t test was applied to compare the outcome in both groups with p≤0.05 considered as significant. Data was stratified for all the effect modifiers like age and gender and post-stratification chi square test was applied to see the effect on the outcome, taking p≤0.05 as significant. Results: The relapse rate of the disease was 0.8±0.72 per year in short-duration group and 1.28±0.61 per year in subjects receiving long-duration steroids, and difference between the two groups was found to be statistically significant (p<0.001). The relapse rate was less in the short duration therapy group as compared to the long duration therapy 62.7% (n=47) patients in group A had one or more relapses of the disease within one year of follow up in contrast to 94.7% (n=71) children in group B (p<0.001). Conclusion: Patients receiving short duration steroid therapy showed a lower relapse rate as compared to those who were administered long term steroids.

References

Andolino TP, Reid-Adam J. Nephrotic Syndrome. Pediatr Rev 2015;36(3):117–25.

Dumas De La Roque C, Prezelin-Reydit M, Vermorel A, Lepreux S, Deminière C, Combe C, et al. Idiopathic nephrotic syndrome: characteristics and identification of prognostic factors. J Clin Med 2018;7(9)258–63.

Vukojevic K, Raguz F, Saraga M, Filipovic N, Bocina I, Kero D, et al. Glomeruli from patients with nephrin mutations show increased number of ciliated and poorly differentiated podocytes. Acta Histochem 2018;120(8):748–56.

Esprit DH, Amin MS, Koratala A. Uncommon things to note about a common cause of nephrotic syndrome. Clin Case Rep 2018;6(8):1645–6.

Lombel RM, Gipson DS, Hodson EM. Kidney Disease: Improving Global Outcomes. Treatment of steroid sensitive nephrotic syndrome: new guidelines from KDIGO. Pediatr Nephrol 2013;28(3):415–26.

Thalgahagoda S, Karunadasa UI, Kudagammana ST, Abeyagunawardena S, Jayaweera H, Abeyagunawardena A, et al. Long-term tapering regimen of prednisolone for the initial episode of nephrotic syndrome. Sri Lanka J Child Health 2017;46(4):331–6.

Dinçel N, Yılmaz E, Kaplan Bulut İ, Hacıkara Ş, Mir S. The long-term outlook to final outcome and steroid treatment results in children with idiopathic nephrotic syndrome. Ren Fail 2015;37(8):1267–72.

Batishcheva GA, Zhdanova OA, Nastausheva TL, Chernov YN. Characteristics of adverse side effects of corticosteroid therapy in children with nephrotic syndrome and methods of pharmacological correction. RR Pharmacol 2019;5(1):37–43.

Baek HS, Park KS, Kang HG, Ko CW, Cho MH. Initial steroid regimen in idiopathic nephrotic syndrome can be shortened based on duration to first remission. Korean J Pediatr 2015;58(6):206–10.

Hahn D, Hodson EM, Willis NS, Craig JC. Corticosteroid therapy for nephrotic syndrome in children. Cochrane Database Syst Rev 2015;2015(3):CD1533.

Emad Momtaz H, Al Sadat Sharif A, Amri A. Comparison of eight-week and twelve-week corticosteroid treatment regimens in children with idiopathic nephrotic syndrome; A clinical trial. J Renal Inj Prev 2020;9(3):e25.

Sinha A, Saha A, Kumar M, Sharma S, Afzal K, Mehta A, et al. Extending initial prednisolone treatment in a randomized control trial from 3 to 6 months did not significantly influence the course of illness in children with steroid-sensitive nephrotic syndrome. Kidney Int 2015;87:217–24.

Webb NJ, Woolley RL, Lambe T, Frew E, Brettell EA, Barsoum EN, et al. Sixteen-week versus standard eightweek prednisolone therapy for childhood nephrotic syndrome: the PREDNOS RCT. Health Technol Assess 2019;23(26):1–108.

Paul SK, Muinuddin G, Jahan S, Begum A, Rahman M, Hossain MM. Long versus standard initial prednisolone therapy in children with idiopathic nephrotic syndrome. Mymensingh Med J 2014;23(2):261–7.

Yoshikawa N, Nakanishi K, Sako M, Oba MS, Mori R, Ota E, et al. A multicenter randomized trial indicates initial prednisolone treatment for childhood nephrotic syndrome for two months is not inferior to six - month treatment. Kidney Int 2015;87(1):225-32.

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Published

2022-03-03