Management of Nephrotic Syndrome in Pediatric Patients Treated by Different Steroid Regimens

TL;DR

This study compares different steroid treatment regimens for managing nephrotic syndrome in children and finds no significant benefit from longer steroid use.

Contribution

The study provides empirical evidence comparing steroid regimens for pediatric nephrotic syndrome, challenging assumptions about treatment duration and efficacy.

Findings

Group 3 (3640 mg/m2) had the lowest percentage of patients with ≥5 relapses.

Children aged 2-6 years were most likely to develop frequently relapsing NS across all groups.

No correlation was found between longer steroid treatment and better outcomes or fewer relapses.

Abstract

Background and Objectives: The nephrotic syndrome (NS) is the most common acquired childhood kidney disease. Steroids represent the cornerstone of the therapeutic strategy, representing the first-line approach, but optimal therapeutic management is debated. This study aimed to compare different steroid therapeutic management protocols. Patients and Methods: A total of 140 NS pediatric patients were enrolled retrospectively. All the kids were divided among three different groups according to the three different steroid therapeutic schemes: 2240 mg/m2 (group 1), 3360 mg/m2 (group 2), or 3640 mg/m2 (group 3) and divided in frequently relapsing (FR-NS) or steroid-dependent (SD) NS. Results: Within group 1, 50% of the population developed FR-NS; 100% of those kids were between 2 and 6 years old. Within the second group, 54% of the patients developed FR-NS, and 83% of these kids were between 2 and 6 years old, i.e., 45% of the group population. Within group 3, 45% of the patients developed FR-NS, and 70% of these kids were among 2 and 6 years old, i.e., 32% of the group population. This group exhibits the lowest percentage (42%) of patients in the highest relapse category (≥5 relapses) compared to the other protocols, indicating that this protocol might be more effective at reducing the number of frequent relapses. No specific predictor factors of FR- or SD-NS were revealed in the studied cohort. Conclusions: A longer steroid scheme does not correlate with a better outcome, nor does it reduce the number of relapses or prevent steroid failure.

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