Document Detail


Long versus standard initial steroid therapy for children with the nephrotic syndromeA report from the Southwest Pediatric Nephrology Study Group.
MedLine Citation:
PMID:  12700959     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A retrospective cohort study was conducted by the Southwest Pediatric Nephrology Study Group (SPNSG) to address whether a longer initial course of corticosteroids in patients with idiopathic nephrotic syndrome (INS) provides superior protection against relapse without increased adverse effects. In order to be included in the evaluation, patients with INS must have responded to an initial steroid course, either standard or long regimen as defined here, and completed at least 1 year of follow-up. The standard regimen consisted of prednisone 2.0+/-0.3 mg/kg per day or 60+/-10 mg/m(2) per day for 28+/-4 days, followed by alternate-day prednisone for 4-12 weeks. The long regimen consisted of daily prednisone 2.0+/-0.3 mg/kg per day or 60+/-10 mg/m(2) per day for 42+/-6 days, followed by alternate-day prednisone for 6-14 weeks. The primary outcome measure was relapse of NS within 12 months of discontinuing the initial course of prednisone. There were 151 children who met the criteria for the study; 82 received the standard regimen and 69 the long regimen. The two groups did not differ in age, race, blood pressure, serum albumin, or serum cholesterol prior to the initial steroid course. The cumulative prednisone dose was 49% higher in the long regimen group than in the standard regimen group. Relapse within 12 months was reported in 72.5% of patients who received the long regimen versus 84.1% of those who received the standard regimen. The odds ratio for relapse within 12 months was 0.496 (95% confidence interval 0.22, 1.088), long versus standard regimen. This did not reach statistical significance ( chi(2)=3.058, P=0.08). The odds ratio of experiencing at least one side effect was 3.76, long relative to standard regimen ( n=133, P<0.001). Our data suggest that prolongation of the steroid treatment for the initial episode of steroid-sensitive NS may have a beneficial effect, but at the cost of increased side effects. However, definitive conclusions are limited by the retrospective design of the study and the number of patients. This may have caused failure to achieve statistical significance on the basis of a type II error.
Authors:
Marc B Lande; Christina Gullion; Ronald J Hogg; Bernard Gauthier; Binod Shah; Mary B Leonard; Melvin Bonilla-Felix; Martin Nash; Shane Roy; C Frederic Strife; Gerald Arbus
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Publication Detail:
Type:  Journal Article     Date:  2003-03-21
Journal Detail:
Title:  Pediatric nephrology (Berlin, Germany)     Volume:  18     ISSN:  0931-041X     ISO Abbreviation:  Pediatr. Nephrol.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-17     Completed Date:  2003-12-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8708728     Medline TA:  Pediatr Nephrol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  342-6     Citation Subset:  IM    
Affiliation:
University of Rochester, Rochester, New York, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Anti-Inflammatory Agents / administration & dosage,  adverse effects,  therapeutic use
Blood Pressure / drug effects
Canada
Child
Child, Preschool
Dose-Response Relationship, Drug
Female
Glomerular Filtration Rate / drug effects
Humans
Infant
Male
Nephrotic Syndrome / drug therapy*,  physiopathology
Prednisone / administration & dosage,  adverse effects,  therapeutic use
Retrospective Studies
Risk Assessment
Steroids / adverse effects,  therapeutic use*
Time Factors
United States
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Steroids; 53-03-2/Prednisone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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