LOW DOSE PREDNISOLONE WITH INCREASE IN DOSAGE INTERVAL IN FREQUENT RELAPSING NEPHROTIC SYNDROME

In order to avoid using cytotoxic drugs and to minimize prednisolone side effects in frequent relapsing or steroid-dependent idiopathic nephrotic syndrome, 35 patients, 3 to 15 (mean= 8.1) years of age, were studied. While in remission for at least 6 weeks, the dose of prednisolone was reduced to 0.1-0.37 (mean= 0.23) mg/kg/day as a single dose for 12 to 72 (mean= 27.6) months. It was followed by a tapering method, with gradual increase in the interval instead of decrease in the dose for about 10 to 12 months, and about 18.4 months follow-up without treatment. About 54.3% of the patients had no relapse during the treatment period and the relapse rate per patient per year was 3.94 during the preceding 12 months before the study, 0.51 during treatment (p<0.001) and 0.23 after discontinuation of the drug. Each relapse was treated by a standard dose of prednisolone for 2 months and then the low dose regimen was resumed. The patients tolerated the drug well with minimal side effects. It is concluded that long term, low-dose daily prednisolone therapy followed by gradual increase in the interval is a safe, well-tolerated and effective method of maintaining prolonged remission in most children with frequent relapsing idiopathic nephrotic syndrome.