Initial Prednisolone Treatment for Primary Nephrotic Syndrome in Children-4 Weeks versus 6 Weeks

Choi, Jung Youn; Park, Mi Young; Kim, Hye Suk; Lee, Kyung Hoon; Kim, Jun Sik; Park, Yong Hoon

J Korean Soc Pediatr Nephrol > Volume 9(2); 2005 > Article

J Korean Soc Pediatr Nephrol 2005;9(2): 159-166.

일차성 신증후군 환아의 첫 관해를 위한 4주와 6주 스테로이드 치료 비교

최정연, 박미영, 김혜숙, 이경훈, 김준식, 박용훈

¹영남대학교 의과대학 소아과학교실
²영남대학교 의과대학 소아과학교실
³대구 파티마병원 소아과
⁴대구카톨릭대학교 의과대학 소아과학교실
⁵계명대학교 의과대학 소아과학교실
⁶영남대학교 의과대학 소아과학교실

Initial Prednisolone Treatment for Primary Nephrotic Syndrome in Children-4 Weeks versus 6 Weeks

Jung Youn Choi, Mi Young Park, Hye Suk Kim, Kyung Hoon Lee, Jun Sik Kim, Yong Hoon Park

¹Department of Pediatricic, College of Medicine, Yeungnam University
²Department of Pediatricic, College of Medicine, Yeungnam University
³Department of Pediatrics, Fatima Hospital
⁴Department of Pediatrics, College of Medicine Catholic University
⁵Department of Pediatrics, College of Medicine Keimyung University
⁶Department of Pediatricic, College of Medicine, Yeungnam University

ABSTRACT

Purpose : Recently the merits of 6 weeks of initial prednisolone treatment for pediatric primary nephrotic syndrome have been reported, and the use of the 6 week regimen is increasing. We compared our experiences with the 6 week treatment versus the 4 week treatment for Korean patients.
Methods : We conducted a retrospective analysis of 69 children who had primary nephrotic syndrome and who were followed up for at least 12 months in the 4 major medical centers in Daegu. The remission rate, the relapse rate, the frequency of relapse and complication of steroid treatment were compared between the 4 weeks and 6 weeks treatment group.
Results : Of the 69 children, 42 were in the 4 week treatment group and 27 were in the 6 week group. The median age, blood pressure, serum total protein, serum albumin, cholesterol, creatinine, estimated creatinine clearance, 24 hour urine protein and 12 month cumulative dose did not differ between the two groups. Among the children who relapsed after steroid treatment, the relapse time was significantly later for the 6 week treatment group. The relapse rate after 1 year of treatment was 62$%$ in the 4 week treatment group and 52$%$ in the 6 week treatment group; however, there was no statistically significant difference between the two groups. The frequency of relapse at 12 months was $1.5{pm}1.2$ times in the 4 week treatment group and $1.1{pm}1.2$ times in the 6 week treatment group, and there was not different between the two groups. The most common side effects of steroid treatment were an increase of appetite and a cushingoid appearance, and there was no statistical difference between the two groups. Among the 27 children who had kidney biopsies performed, 21 suffered from minimal change nephrotic syndrome.
Conclusion : The first relapse time after steroid treatment was significantly later in the 6 week steroid treatment group. The frequency of relapse and the 12 month cumulative dose of steroid were lower in the 6 week treatment group, but there was no statistical significance between the two groups. The side effects of steroid treatment did not differ between the two groups. We need to study the long term side effects and the advanced regimens of steroid treatment in the future.(J Korea Soc Pediatr Nephrol 2005;9:159-166)

Key words: Primary nephrotic syndrome | Initial steroid treatment | 4 weeks | 6 weeks regimen