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Corticosteroid therapy for nephrotic syndrome in children

Overview of attention for article published in Cochrane database of systematic reviews, January 2007
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Title
Corticosteroid therapy for nephrotic syndrome in children
Published in
Cochrane database of systematic reviews, January 2007
DOI 10.1002/14651858.cd001533.pub4
Pubmed ID
Authors

Hodson, E M, Willis, N S, Craig, J C

Abstract

In nephrotic syndrome (NS) protein leaks from the blood to the urine through the glomeruli resulting in hypoproteinaemia and generalised oedema. While the majority of children with NS respond to corticosteroids, 70% experience a relapsing course. Corticosteroids have reduced the mortality rate to around 3%. However corticosteroids have well recognised potentially serious adverse effects such as obesity, poor growth, hypertension, diabetes mellitus and osteoporosis. To determine the benefits and harms of corticosteroid regimens in preventing relapse in children with steroid sensitive NS (SSNS). We searched CENTRAL, Cochrane Renal Group Specialised Register, MEDLINE and EMBASE without language restriction, reference lists of articles and contact with known investigators. Date of last search: December 2006 Randomised controlled trials performed in children (three months to 18 years) in their initial or subsequent episode of SSNS, comparing different durations, total doses or other dose strategies using any corticosteroid agent, with outcome data at six months or more. Two authors independently assessed trial quality and extracted data. Results were expressed as relative risk (RR) with 95% confidence intervals (CI) or mean difference (WMD). Meta-regression was used to explore potential between-study differences due to baseline risk of relapse, study quality and interventions. Twenty four trials were identified. Six trials comparing two months of prednisone or prednisolone with three months or more in the first episode showed longer duration significantly reduced the risk of relapse at 12 to 24 months (RR 0.70, 95% CI 0.58 to 0.84). There was an inverse linear relationship between treatment duration and risk of relapse (RR = 1.26 - 0.112 duration; P = 0.03). Four trials showed that six months of prednisone was more effective than three months in reducing the risk for relapse (RR 0.57; 95% CI 0.45 to 0.71). Deflazacort was significantly more effective in maintaining remission than prednisone in children who frequently relapsed in a single study (RR 0.44, 95% CI 0.25 to 0.78). There were no increases in adverse events. Children in their first episode of SSNS should be treated for at least three months with an increase in benefit for up to seven months of treatment. For a baseline risk for relapse following the first episode of 60% with two months of therapy, daily prednisone or prednisolone given for four weeks followed by alternate-day therapy for six months would reduce the number of children relapsing by 33%.

Mendeley readers

The data shown below were compiled from readership statistics for 49 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Malaysia 1 2%
Indonesia 1 2%
Italy 1 2%
Brazil 1 2%
United States 1 2%
Unknown 44 90%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 8 16%
Student > Master 7 14%
Student > Bachelor 7 14%
Researcher 5 10%
Other 5 10%
Other 15 31%
Unknown 2 4%
Readers by discipline Count As %
Medicine and Dentistry 35 71%
Psychology 3 6%
Social Sciences 2 4%
Nursing and Health Professions 1 2%
Biochemistry, Genetics and Molecular Biology 1 2%
Other 1 2%
Unknown 6 12%