Study Between Two Prolonged Corticosteroid Regimes For the First Episode of Steroid Sensitive Nephrotic Syndrome(SSNS) Resulting in Highly Favorable Outcome with Slow Monthly Tapering Course

Background: Benefits of prolonged steroid therapy in the initial episode of SSNS has been challenged by few randomized controlled trials published recently. Results of our 7 months regime(Published in the Cochrane data base by its reviewers Hodson et al) constantly show favorable outcome.

Objective: To consolidate the benefit of treating initial episode and relapses with a prolonged slow tapering course of steroid against a prolonged but rapid steep dose reduction course.

Method: Clinical trial (Registered in the SLCTR/2016/027) with 48 children presented to University renal clinic Galle Sri Lanka from November 2016 to 2019 with initial episode of SSNS randomized to 7 months regime( prednisolone 60mg/m2/day for 28days followed by EOD course with monthly tapering by 10mg/m2. Relapses were treated with a similar tapering course) and to KDIGO regime( 60mg/m2 daily for 42 days followed by 40mg/m2 EOD 42 days. Then EOD course of 30mg/m2 , 22.5mg/m2 and 15mg/m2 month each. Relapses treated with 60mg/m2 until proteinuria free 3 days followed by 40mg/m2 EOD for 28 days).

Results: Duration of remission after the initial episode in the experimental group was 19.6 months (SD12.0) while, 11.5 (SD12.3) in the KDIGO group. P

Conclusion: Prolonged steroid course with slow tapering over 7 months with similar tapering course for the relapses is the ideal way to give a prolonged steroid therapy to get a beneficial effect.