OUTCOME OF SHORT AND LONG DURATION STEROID THERAPY IN CHILDHOOD NEPHROTIC SYNDROME IN TERMS OF FREQUENCY OF RELAPSE RATE
DOI:
https://doi.org/10.55519/JAMC-02-9324Keywords:
Steroid sensitive, Nephrotic syndrome, relapse, steroidsAbstract
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.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
