Division of Pediatric Nephrology, Institute of Child Health, Kolkata, India.
Department of Pediatrics, Mission Hospital, Durgapur, India.
Clin J Am Soc Nephrol. 2023 Oct 1;18(10):1294-1299. doi: 10.2215/CJN.0000000000000216. Epub 2023 Jun 19.
Early morning single-dose prednisolone has a hypothetical advantage of less hypothalamic-pituitary-adrenal (HPA) axis suppression, but lack of robust evidence has resulted in variation in practice, with divided-dose prednisolone still commonly used. We conducted this open-label randomized control trial to compare HPA axis suppression between single-dose or divided-dose prednisolone among children with first episode of nephrotic syndrome.
Sixty children with first episode of nephrotic syndrome were randomized (1:1) to receive prednisolone (2 mg/kg per day), either as single or two divided doses for 6 weeks, followed by single alternative daily dose of 1.5 mg/kg for 6 weeks. The Short Synacthen Test was conducted at 6 weeks, with HPA suppression defined as postadrenocorticotropic hormone cortisol <18 µ mg/dl.
Four children (single=1 and divided dose=3) did not attend the Short Synacthen Test and were hence excluded from analysis. Remission was induced in all, and no relapse postremission was noted during the 6+6 weeks of steroid therapy. After 6 weeks of daily steroids, HPA suppression was greater in divided (100%) versus single dose (83%) ( P = 0.02). Time to remission and final relapse rates were similar, but for those children who relapsed within 6 months of follow-up period, time to first relapse was shorter for divided dose (median 28 versus 131 days) P = 0.002.
Among children with first episode of nephrotic syndrome, single-dose and/or divided-dose prednisolone were equally effective in inducing remission with similar relapse rates, but single dose had less HPA suppression and longer time to first relapse.
CTRI/2021/11/037940.
This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_10_09_CJN0000000000000216.mp3.
清晨单次剂量的泼尼松具有假设的下丘脑-垂体-肾上腺（HPA）轴抑制作用较小的优势，但缺乏有力的证据导致实践中的差异，仍常使用分剂量泼尼松。我们进行了这项开放标签随机对照试验，比较了首次肾病综合征发作的儿童中单剂量或分剂量泼尼松之间的 HPA 轴抑制作用。
60 名首次肾病综合征发作的儿童被随机（1:1）接受泼尼松（2 mg/kg/天），分别单剂量或分两次剂量治疗 6 周，随后再用 1.5 mg/kg 单剂量隔日治疗 6 周。在第 6 周进行短 Synacthen 试验，HPA 抑制定义为促肾上腺皮质激素后皮质醇<18 µg/dl。
4 名儿童（单剂量=1 名，分剂量=3 名）未参加短 Synacthen 试验，因此被排除在分析之外。所有儿童均诱导缓解，在 6+6 周的类固醇治疗期间无缓解后复发。在每天使用类固醇 6 周后，分剂量组（100%）的 HPA 抑制作用大于单剂量组（83%）（P=0.02）。缓解时间和最终复发率相似，但对于在随访期内 6 个月内复发的儿童，分剂量组的首次复发时间更短（中位数 28 天与 131 天），P=0.002。
在首次肾病综合征发作的儿童中，单剂量和/或分剂量泼尼松在诱导缓解方面同样有效，复发率相似，但单剂量组的 HPA 抑制作用较小，首次复发时间较长。
CTRI/2021/11/037940。
本文包含一个播客，可在 https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_10_09_CJN0000000000000216.mp3 上找到。
