eISSN: 1644-4124
ISSN: 1426-3912
Central European Journal of Immunology
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SCImago Journal & Country Rank
3/2021
vol. 46
 
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abstract:
Clinical immunology

Treatment of idiopathic nephrotic syndrome with two steroid dosing regimens – one-year observational study

Małgorzata Pańczyk-Tomaszewska
1
,
Piotr Skrzypczyk
1
,
Kacper Mroczkowski
2
,
Beata Leszczyńska
1
,
Małgorzata Mizerska-Wasiak
1

1.
Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
2.
Student Scientific Group at the Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
Cent J Eur Immunol 2021; 46 (3): 344-350
Online publish date: 2021/10/06
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Introduction
The aim of the study was to compare the first year of disease in children with idiopathic nephrotic syndrome (INS) treated according to two prednisone dosing regimens: a weight-based schedule (2 mg/kg/24 h in the 1st month, 2 mg/kg/48 h in the 2nd month, with dose tapering during the following 4 months), and a body surface area (BSA)-based schedule (60 mg/m2/24 h in the 1st month, 40 mg/m2/48 h in the 2nd month, with dose tapering during the following 4 months).

Material and methods
In 2 groups of children treated with weight- and BSA-based regimens (20 patients, 3.13 ±1.01 years, treated in 2010-2013 and 20 patients, 5.13 ±2.86 years, treated in 2014-2016) clinical and anthropometrical parameters, number of INS relapses, total prednisone dose (mg/kg/year), and steroid adverse effects were compared during the first year of disease.

Results
Children treated with the weight-based steroid regimen received a higher total annual prednisone dose (259.06 ±79.54 vs. 185.83 ±72.67 mg/kg/24 h, p = 0.004) and had a shorter (though not significantly) period without prednisone (38.25 ±55.83 vs. 75.90 ±73.06 days, p = 0.062) compared to patients treated with the BSA-based regimen. There was no difference in number of relapses between groups (2.20 ±1.64 vs. 1.60 ±1.67, p = 0.190) but more patients relapsed in the weight-based group (19/20 vs. 13/20, p = 0.044). No differences in Z-score values of height, weight, and body mass index (BMI) were observed. No steroid-related adverse events were noted except for arterial hypertension (4/20 vs. 5/20 patients, p = 1.000).

Conclusions
The BSA-based regimen of prednisone dosing in children with INS reduces exposure to steroids and risk of relapse, as well as increases days off steroids in the first year compared to the weight-based regimen with a high second-month dose.

keywords:

children, prednisone, idiopathic nephrotic syndrome, dosing regimen, glucocorticoids

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