Drawn Out Rx for Kidney Disease Kids

Nephrotic syndrome relapse rates not improved through extended steroid use

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Steroids are often used to treat a type of kidney disease common in children. In many cases, this steroid treatment works well at first. However, continuing to use steroids may not be all that helpful.

For most kids with nephrotic syndrome (the most common kidney disease in children), steroids can put the disease in remission, meaning symptoms are reduced or disappear. Unfortunately, symptoms reappear in a majority of these patients.

According to a recent study, extending steroid treatment did not reduce the relapse rate among patients with nephrotic syndrome.

In other words, taking steroids for a longer period of time after remission did not appear to lower the risk of symptoms returning.

"Avoid taking unnecessary drugs."

In children with nephrotic syndrome, the kidneys leak important proteins from the blood into the urine. This puts patients at risk of serious infections and other health problems. Treatment of nephrotic syndrome typically involves steroids such as prednisolone (sold as Pediapred Oral Liquid and Medrol), which often puts the disease into remission.

It was previously thought that extending steroid treatment would give patients a better chance at staying in remission. However, Nynke Teeninga, MD, of Erasmus University Medical Center at Sophia Children's Hospital in the Netherlands, and colleagues found that extended steroid treatment may not be as beneficial as once thought.

Results showed that relapse rates were fairly similar between children with nephrotic syndrome who took steroids for 6 months and those who took steroids for 3 months.

Relapse happened in 48 of 62 patients (77 percent) who took steroids for 3 months. In comparison, relapse happened in 51 of 64 patients (80 percent) who took steroids for 6 months.

Frequent relapses were about as common in both groups, with a rate of 45 percent in the 3-month treatment group and 50 percent in the 6-month treatment group.

"In contrast to what was previously assumed but unproven, we found no beneficial effect of prolonged prednisolone treatment on the occurrence of relapses. We believe our work offers an important contribution towards more evidence-based treatment of childhood nephrotic syndrome," said Dr. Teeninga.

Past findings suggested that extended steroid treatment may reduce relapses. However, these findings probably happened because patients received higher doses rather than because they took steroids for longer periods of time.

According to Dr. Teeninga, future studies should look into preventing relapses through new treatments, especially because frequent relapses are common among children with nephrotic syndrome.

This randomized, double-blind, placebo-controlled trial was conducted at 69 hospitals in the Netherlands. A total of 150 children with nephrotic syndrome between 9 months and 17 years of age were assigned to take prednisolone for 3 months then placebo for 3 months or prednisolone for 6 months. Both groups received equal doses of prednisolone.

The authors disclosed no conflicts of interest. The study was published December 28 in the Journal of the American Society of Nephrology.

Reviewed by: 
Review Date: 
December 30, 2012
Last Updated:
January 3, 2013