A systematic review of corticosteroid therapy in childhood nephrotic syndrome

EM Hodson, JF Knight, NS Willis, JC Craig

Centre for Kidney Research, Royal Alexandra Hospital for Children

The optimal dose and duration of corticosteroid therapy in steroid responsive nephrotic syndrome (SRNS) has not been established. This review aims to assess the benefits and harms of different corticosteroid regimes in preventing relapse in children with SRNS. Published and unpublished randomised and quasi-randomised controlled trials were identified from the Cochrane Controlled Trials Register, Medline (1966-1998), Embase (1988-1998), reference lists of relevant articles, abstracts from proceedings and contact with known investigators in the field. Two reviewers independently reviewed all eligible studies for inclusion using predefined criteria, assessed study quality (concealment allocation, intention to treat, completeness of follow up and blinding of outcome assessment) and extracted data. For dichotomous outcomes odds ratios were calculated for individual studies and a summary odds ratio was calculated using a random effects model after testing for heterogeneity. Continuous variables were analysed using the weighted mean difference. Thirteen controlled trials including 3 in abstract form were identified. Combined analysis of 6 trials comparing different durations of corticosteroid therapy showed that 57% (137/242) children treated for 3 months or more relapsed within 2 years after their first episode of SRNS compared with 66% (107/161) treated for 2 months (OR=0.51;95%CI 0.31-0.83). That is therapy for 3 months or more resulted in 1 additional prolonged remission for every 7 children treated. Mean relapse rate/patient/year was not significantly different between the 2 groups. There was no increase in reported side effects in children treated for 3 months or more. The odds ratio for relapse in children with steroid dependent SRNS treated with deflazacort was 0.07 (95%CI 0.01-0.41) compared with those treated with equivalent doses of prednisone. The analysis indicates that corticosteroid therapy at initial presentation for 3 months or more significantly increases the likelihood of prolonged remission. Deflazacort deserves further study in the treatment of steroid dependent SRNS.

Presented at the Australian and New Zealand Society of Nephrology, Brisbane, March 1999

Correspondence
Dr Elisabeth Hodson
ElisaH@chw.edu.au