Prolonged Corticosteroid Regime is Superior to Two Month regime(ISKDC Regime) in the Management of the Initial Episode of Steroid Sensitive Nephrotic Syndrome( SSNS) in Children

Background: The ISKDC regime of steroid in SSNS is associated with poor outcome leading to high incidence of relapses and FRNS/SDNS.

Objective: To find out the benefits of a prolonged steroid treatment in the initial episode of SSNS.

Method: Total of 190 Children presented with SSNS during 1994 to 2002 to University renal clinic, Galle, Sri Lanka were randomly allocated either to seven month steroid regime(prednisolone 60mg/m2/EOD for 28days followed by an alternate day course with monthly tapering by 10mg/m2 for another 6 months. Relapses were treated with a similar tapering course) or to ISKDC regime( prednisolone 60mg/m2/daily for 28 days followed by 40mg/m2/EOD for 28days and the relapses were given prednisolone 40mg/m2 EOD for 28 days once in remission for 3 days).

Results: Mean duration of remission was 30.2 months (SD30.77) in the7months steroid group and 8.9months (SD12.3) in the ISKDC group. P=0.000. Patients who relapsed in 6months,1year and 2year follow up was 5/89 (6%), 32/89 (32%) and 52/88 (59%) respectively in the prolonged steroid group against 36/101(36%), 79/101(78%) and 88/98(90%) in ISKDC group. P

Relapses per patient per year was 0.42, 0.51, 0.49, 0.52, 0.48 in prolonged steroid regime after 1st ,2nd 3rd ,4th and 5th of follow up against 2.17, 2.02, 1.87, 1.81 and 1.7 in the ISKDC regime. P

Conclusion: Results clearly show that prolonged steroid regime in SSNS with slow tapering course for initial episode and the relapses results in prolonged remission , reduced number of patients who relapsed , low relapse rate per patient per year and reduced rate and late manifestation of FRNS/SDNS.