Older boys benefit from higher initial prednisolone therapy for nephrotic syndrome

Background A long course of the initial prednisolone therapy has been shown to be more effective than standard-course therapy in reducing relapse rate s in children with idiopathic nephrotic syndrome, but it is commonly accomp anied by corticosteroid toxicities. There has been no study on prednisolone dosage for the effective treatment of nephrotic syndrome. Methods. Sixty-eight children (42 boys and 26 girls) with an initial attack of nephrotic syndrome were randomly allocated into two different long-cour se treatment groups. Patients in Group 1 received a daily prednisolone dose of 60 mg/m(2) for six weeks, followed by an alternate-day dose of 40 mg/m( 2) for six weeks. Patients in Group 2 had a daily dose of 40 mg/m(2) instea d of 60 mg/m(2). Results. Four children in each group did not respond within six weeks. Grou p 1 was associated with a significantly earlier response but more frequent corticosteroid toxicities than Group 2. Boys in Group 1 had a higher rate o f sustained remission than boys in Group 2 (P = 0.0073), especially boys fo ur years old or more (P = 0.0027), but girls did not show a significant dif ference (P = 0.863). Boys four years old or more in Group 1 had a course of frequent relapsing less often than those in Group 2 (2 of 13 vs. 6 of 8, P = 0.0075). Conclusion. These findings indicate that efficient prednisolone doses may v ary between sexes and ages, and that a higher initial prednisolone therapy may be of greater benefit to older boys.