Kanai Hiroaki, Goto Miwa, Kobayashi Anna, Sawanobori Emi
Department of Pediatrics, Suwa Central Hospital, Chino, JPN.
Department of Pediatrics, Faculty of Medicine, University of Yamanashi, Chuo, JPN.
Cureus. 2025 Mar 26;17(3):e81247. doi: 10.7759/cureus.81247. eCollection 2025 Mar.
Hospital visits causing psychological stress can trigger nephrotic syndrome relapse in children. While there are reports on preventing relapse during respiratory infections by using low-dose steroids, no reports exist on preventing relapse from other triggers. We describe a case of a patient with repeated relapses triggered by regular hospital visits, which were successfully prevented by administering low-dose prednisolone before the visits. A 14-year-old boy with steroid-dependent nephrotic syndrome was referred and started on mycophenolate mofetil. During the following 14 months, there were nine regular hospital visits. Up to the third of four relapses, urinary proteins appeared on the day of the hospital visit and five and three days before the hospital visit. He experienced two instances of transient proteinuria, with positive urine protein test results on the day of a regular visit. Regular hospital visits were judged to trigger a relapse. At age 16, he was started on prednisolone at 20 mg (approximately 15 mg/m² or 0.5 mg/kg) for prophylaxis five days before regular hospital visits. Thereafter, he no longer experienced relapse or transient proteinuria. However, at age 19, he experienced a relapse related to a hospital visit despite prophylaxis with prednisolone. Since regular hospital visits were discontinued and he was placed under the regular care of a local doctor, prophylactic administration of prednisolone before hospital visits was discontinued. Thereafter, the mycophenolate mofetil dose was tapered off when he was 20 years old. He did not experience a relapse again until age 23. The case shows that low-dose prednisolone administration can prevent hospital visit-related relapse as well as relapse during respiratory infections.
导致心理压力的医院就诊可能会引发儿童肾病综合征复发。虽然有关于使用低剂量类固醇预防呼吸道感染期间复发的报道，但尚无关于预防其他诱因导致复发的报道。我们描述了一例因定期医院就诊引发反复复发的患者，通过在就诊前给予低剂量泼尼松龙成功预防了复发。一名14岁患有类固醇依赖型肾病综合征的男孩前来就诊并开始服用霉酚酸酯。在接下来的14个月里，有9次定期医院就诊。在四次复发中的前三次，尿蛋白在医院就诊当天以及就诊前五天和三天出现。他经历了两次短暂性蛋白尿，在定期就诊当天尿蛋白检测结果呈阳性。定期医院就诊被判定为引发复发的原因。16岁时，他在定期医院就诊前五天开始服用20毫克（约15毫克/平方米或0.5毫克/千克）泼尼松龙进行预防。此后，他不再经历复发或短暂性蛋白尿。然而，19岁时，尽管服用泼尼松龙进行预防，他还是因一次医院就诊经历了复发。由于停止了定期医院就诊，并且他由当地医生进行常规护理，所以在医院就诊前预防性服用泼尼松龙也停止了。此后，20岁时他逐渐减少了霉酚酸酯的剂量。直到23岁他才再次复发。该病例表明，低剂量泼尼松龙给药可以预防与医院就诊相关的复发以及呼吸道感染期间的复发。
