Relapse and steroid resistance in children with nephrotic syndrome Comparison of 8 weeks and 12 weeks steroid therapy protocol

Background : nephrotic syndrome is one of the most common pure renal diseases that a pediatric nephrologist encounters in his /her day to day practice. Initial treatment of primary nephrotic syndrome in children with corticosteroid is a standard of therapy since decades ago, but duration and protocol of steroid treatment is still challenging . in this study we compared recurrence rate in two groups of children with nephrotic syndrome with 8 weeks and 12 weeks course of steroid treatment.Materials and methods:Method:This non randomized clinical trial was performed on 68 children with primary nephrotic syndrome referred to pediatric nephrology clinic. Patients were divided into two groups, group1 (34 patients )received eight weeks of oral prednisolone ( four weeks 2mg/kg/day every day divided to three doses and four weeks 1.5 mg/kg single dose alternate day) and group 2 ( 34 patients) received twelve weeks prednisolone (six weeks 2mg/kg/day every day divided to three doses and six weeks 1.5 mg/kg single dose alternate day), after one year follow up rate of relapse, steroid dependence and steroid resistance was calculated for each group.Results: In group 1, mean age of patients was 4 ± 1.67 year, 64.7% (22 patients) were male and 35.3% (12 patients) were female. In group 2 mean age was 4.09 ± 1.97 year, 70.6% (24 patients) were male and 29.4% (10 patients) were female. Difference of age and sex distribution was not significant. In group 1 ( eight weeks steroid) rate of frequent relapses, steroid dependence and steroid resistance was 26.5%, 17.6% and 8.8% accordingly. In group 2 ( twelve weeks steroid) rate of frequent relapses,steroid dependence and steroid resistance was 11.8%, 8.8% and 5.9% accordingly. Group 1 patients had 47.1% rate of remission and occasional relapse and group 2 had 73.5% of remission and occasional relapse . in comparison rates of frequent relapses, steroid dependence and steroid resistance were significantly lower in group 2 than group 1 ( P value 0.026).Conclusion: twelve weeks steroid treatment protocol is associated with significant lower rate of frequent relapses, steroid dependence and steroid resistance compared to eight weeks steroid protocol, although increased risk of prolonged steroid treatment should be considered in this protocol of treatment of nephrotic syndrome.