Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Initial steroid regimen in idiopathic nephrotic syndrome can be shortened based on duration to first remission

  • Baek, Hee Sun (Department of Pediatrics, Kyungpook National University School of Medicine) ;
  • Park, Ki-Soo (Department of Preventive Medicine and Institute of Health Sciences, Gyeongsang National University Hospital) ;
  • Kang, Hee Gyung (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Ko, Cheol Woo (Department of Pediatrics, Kyungpook National University School of Medicine) ;
  • Cho, Min Hyun (Department of Pediatrics, Kyungpook National University School of Medicine)
  • Received : 2014.09.30
  • Accepted : 2014.11.14
  • Published : 2015.06.10
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Abstract

Purpose: The use of a 12-week steroid regimen (long-term therapy, LT) for the first episode of idiopathic nephrotic syndrome (NS) reportedly induces a more sustained remission and lower relapse rate than previous regimens, including an 8-week steroid regimen (short-term therapy, ST). Here, we assessed the potential for selective application of 2 steroid regimens (LT vs. ST) based on the days to remission (early responders [ER] vs. late responders [LR]) for the first idiopathic NS episode in children. Methods: Patients were divided into 4 subgroups (ST+ER, ST+LR, LT+ER, and LT+LR) according to the initial steroid regimen used and rapidity of response; the baseline characteristics, relapse rates, and cumulative percentage of children with sustained remission were then compared among the 4 subgroups. Results: Fifty-four children received ST, and the remaining 45 children received LT. As observed in previous studies, children receiving LT showed significantly lower relapse rates during the first year after the first NS episode than those receiving ST. The ST+ER group showed significantly lower relapse rates during the first one year and two years after the first NS episode than the the ST+LR group, whereas there were no significant differences of the relapse rates and duration to the first relapse between the ST+ER and LT+ER groups. Conclusion: We suggest that the initial steroid regimen in idiopathic NS patients can be shortened according to the duration to remission i.e., LT in patients achieving remission after the first week of steroid therapy, and ST in those achieving remission within the first week of steroid therapy.

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References

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