Abeyagunawardena Asiri S, Thalgahagoda R S, Dissanayake Pathum V, Abeyagunawardena Shamali, Illangasekera Y A, Karunadasa Umeshi I, Trompeter Richard S
Faculty of Medicine, Department of Paediatrics, University of Peradeniya, Peradeniya, Sri Lanka.
Out-patient Department of Medicine, Teaching Hospital Peradeniya, Peradeniya, Sri Lanka.
Pediatr Nephrol. 2017 Aug;32(8):1377-1382. doi: 10.1007/s00467-017-3640-5. Epub 2017 Mar 24.
Relapses of childhood nephrotic syndrome (NS) are frequently precipitated by viral upper respiratory tract infections (URTIs). A review of the literature reveals that in patients with steroid-dependent NS on alternate day corticosteroids, a short course of daily corticosteroid therapy during the course of an URTI may reduce relapse frequency.
To assess the effect of a short course of low-dose corticosteroid therapy during the course of an URTI on relapse frequency in patients with steroid-sensitive NS who have not been taking any treatment for a minimum period of 3 months.
A double-blind placebo-controlled crossover trial was conducted on 48 patients with idiopathic NS who had not been receiving corticosteroid therapy for a minimum of 3 months. Patients were randomized into two groups. Group A received 5 days of daily prednisolone at 0.5 mg/kg at the onset of an URTI while group B received 5 days of placebo. Both groups were followed up for 1 year and the URTI-induced relapse frequency was noted. A crossover was performed during the next year, with group A receiving placebo and group B receiving prednisolone.
Thirty-three patients completed the study. In the treatment group, 115 episodes of URTI led to 11 relapses while in the control group 101 episodes of URTI led to 25 relapses. There was no significant difference between the mean number of URTIs between the treatment and control groups. The treatment group had significantly less relapses compared to the control group (p = 0.014). Within the treatment group, 65.6% did not relapse, while the remainder had a single relapse. In contrast, only 40.6% of the control group remained in remission while 40.6% suffered a single relapse and 18.8% had two or more relapses.
Prescribing a short course of daily corticosteroids during an URTI significantly reduces the frequency of URTI-induced relapse in patients with steroid-responsive NS who are off corticosteroid therapy.
儿童肾病综合征（NS）的复发常由病毒性上呼吸道感染（URTI）诱发。文献综述显示，对于隔日服用皮质类固醇的激素依赖型NS患者，在URTI病程中进行短期每日皮质类固醇治疗可能会降低复发频率。
评估在URTI病程中进行短期低剂量皮质类固醇治疗对至少3个月未接受任何治疗的激素敏感型NS患者复发频率的影响。
对48例至少3个月未接受皮质类固醇治疗的特发性NS患者进行了一项双盲安慰剂对照交叉试验。患者被随机分为两组。A组在URTI发作时每日服用泼尼松龙0.5mg/kg，共5天，而B组服用5天安慰剂。两组均随访1年，并记录URTI诱发的复发频率。次年进行交叉试验，A组服用安慰剂，B组服用泼尼松龙。
33例患者完成了研究。治疗组中，115次URTI发作导致11次复发，而对照组中101次URTI发作导致25次复发。治疗组和对照组的URTI平均发作次数无显著差异。与对照组相比，治疗组的复发次数明显更少（p = 0.014）。在治疗组中，65.6%的患者未复发，其余患者复发一次。相比之下，对照组中只有40.6%的患者保持缓解，40.6%的患者复发一次，18.8%的患者复发两次或更多次。
在URTI期间开具短期每日皮质类固醇处方可显著降低停用皮质类固醇治疗的激素反应型NS患者因URTI诱发的复发频率。
