SINGLE-VERSUS DIVIDED-DOSE PREDNISOLONE THERAPY FOR RELAPSES OF NEPHROTIC SYNDROME

Relapses of nephrotic syndrome are usually treated with prednisolone, initially in three to four daily divided doses. The divided-dose regim en may cause poor patient compliance and greater adrenal suppression. In a prospective randomized controlled trial, we compared the efficacy of prednisolone in inducing remission of nephrotic syndrome, when giv en either as a single dose or in divided doses. Patients with steroid- responsive nephrotic syndrome with relapse were randomized to receive prednisolone 2 mg/kg per day, either as a single morning dose or in th ree divided doses for 2 weeks, followed by 1.5 mg/kg on every alternat e day for 4 weeks. Parents tested the urine for protein daily until re mission (nil proteinuria for 3 consecutive days). The duration between initiation of treatment and achievement of remission was recorded. Of 106 patients, 94 (47 each in single-dose and divided-dose groups) com pleted the study. The patients in the two groups were similar in relat ion to age, sex, number of relapses in the preceding year, and blood l evels of creatinine, albumin, and cholesterol. The mean time for achie vement of remission in the single-and divided-dose groups was 8.6 and 8.5 days, respectively (P = 0.94, power 96%). After 9 months' follow-u p, there were no differences in the frequency of relapses and cumulati ve dose of prednisolone received in the two groups. The observations s uggest that prednisolone administered in a single daily dose or in div ided doses is equally effective in inducing remission in patients with relapsing nephrotic syndrome.