Raja Karnika, Parikh Ami, Webb Hazel, Hothi Daljit
Department of Paediatric Nephrology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK.
Pediatr Nephrol. 2017 Jan;32(1):99-105. doi: 10.1007/s00467-016-3458-6. Epub 2016 Sep 27.
Relapses of nephrotic syndrome are common and are treated with a course of prednisolone (2 mg/kg/day or 60 mg/m/day). This is associated with major adverse effects including diabetes, weight gain, hypertension and behavioural problems. This study is a retrospective review examining the success of treating relapses in steroid-sensitive nephrotic syndrome (SSNS) with low-dose prednisolone and the consequences on subsequent relapse rates. Furthermore, a follow-up study looked at the side-effect profile during treatment with high- versus low-dose prednisolone.
Between January 2012 and July 2013, all well children with SSNS presenting with a relapse were advised to start 1 mg/kg prednisolone daily for a maximum of 7 days. In July 2015, we compared the side-effect profile of prednisolone therapy using the parent proxy PedsQL questionnaire for quality of life (QoL).
Fifty patients were included in the study, with a total of 87 relapses. Sixty-one of the 87 relapses (70 %) responded within a week. Treating relapses with a reduced dose of steroids did not adversely affect the relapse rate in the 6 months preceding and following the current relapse (1.01 vs 0.86, p = 0.3). Fifteen parents completed the PedsQL questionnaire. Comparison of scores in each category showed significantly higher values in each domain during treatment with low-dose prednisolone compared with high-dose treatment (35.6 vs 18.3, p < 0.0001; 31.1 vs 15.0, p < 0.001; 38.3 vs 20.1, p < 0.0001).
A low-dose prednisolone regimen was successful in achieving remission in 70 % of relapses of children with SSNS, without adversely affecting the relapse rate. Parent-completed QoL questionnaires showed significantly higher scores on low-dose treatment, indicating better QoL.
肾病综合征的复发很常见，通常采用泼尼松龙疗程治疗（2毫克/千克/天或60毫克/平方米/天）。这会带来包括糖尿病、体重增加、高血压和行为问题在内的主要不良反应。本研究是一项回顾性分析，旨在探讨用低剂量泼尼松龙治疗激素敏感性肾病综合征（SSNS）复发的成功率以及对后续复发率的影响。此外，一项随访研究观察了高剂量与低剂量泼尼松龙治疗期间的副作用情况。
在2012年1月至2013年7月期间，所有复发的SSNS健康儿童均被建议开始每日服用1毫克/千克泼尼松龙，最长服用7天。2015年7月，我们使用家长代理的儿童生活质量量表（PedsQL）问卷比较了泼尼松龙治疗的副作用情况。
50名患者纳入研究，共出现87次复发。87次复发中有61次（70%）在一周内有反应。用减量类固醇治疗复发对当前复发前后各6个月的复发率没有不利影响（1.01对0.86，p = 0.3）。15名家长完成了PedsQL问卷。各类别得分比较显示，与高剂量治疗相比，低剂量泼尼松龙治疗期间每个领域的得分均显著更高（35.6对18.3，p < 0.0001；31.1对15.0，p < 0.001；38.3对20.1，p < 0.0001）。
低剂量泼尼松龙方案成功使70%的SSNS儿童复发得到缓解，且未对复发率产生不利影响。家长完成的生活质量问卷显示，低剂量治疗得分显著更高，表明生活质量更好。
