Outcome of low dose daily versus standard alternate day prednisolone for frequent relapse nephrotic syndrome in children

M. Masum Billah; Tanjila Afrin; Sadia Shamsad; Anjuman Ara Khatun; M. Reaz Uddin; M. Anwar Hossain Khan; A. B. M. Mahbub Ul Alam

doi:10.18203/2349-3291.ijcp20260817

Authors

M. Masum Billah Department of Paediatric Nephrology, National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh
Tanjila Afrin Department of Paediatric Nephrology, National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh
Sadia Shamsad Department of Paediatric Surgery, Evercare Hospital, Dhaka, Bangladesh
Anjuman Ara Khatun Department of Paediatric Nephrology, National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh
M. Reaz Uddin Department of Paediatric Nephrology, National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh
M. Anwar Hossain Khan Department of Paediatric Nephrology, National Institute of Kidney Diseases and Urology, Dhaka, Bangladesh
A. B. M. Mahbub Ul Alam Department of Paediatrics, Bikrampur Bhuiyan Medical College, Shreenagar, Munshigonj, Bangladesh

DOI:

https://doi.org/10.18203/2349-3291.ijcp20260817

Keywords:

Frequent-relapse nephrotic syndrome, Paediatric nephrology

Abstract

Background: Nephrotic syndrome is a common chronic glomerular disorder in children, with frequent relapses causing significant clinical and psychosocial burden. Prednisolone remains the cornerstone of therapy, typically administered on an alternate-day schedule for maintenance. However, low daily-dose regimens may improve relapse control with fewer adverse effects, particularly in resource-limited settings.

Methods: This quasi-experimental study included 72 children aged 2-12 years with FRNS treated at the National Institute of Kidney Diseases and Urology, Dhaka, between August 2022 and August 2024. Participants received either daily low-dose prednisolone (0.2 mg/kg; Group A, n=31) or alternate-day prednisolone (0.5 mg/kg; Group B, n=32) for six months. Clinical features, anthropometric measurements, laboratory findings, relapse frequency, and steroid-related adverse effects were assessed at baseline, 3 months, and 6 months. Data were analyzed using independent T-tests and chi-square tests, with p<0.05 considered significant.

Results: Baseline characteristics were comparable. At 6 months, oedema, ascites, and significant proteinuria were more frequent in Group B (70% vs. 41.4%, p=0.027). Group A had a lower cumulative prednisolone dose (60.57±24.79 mg/kg vs. 76.01±14.21 mg/kg, p=0.005), fewer Cushingoid features (3.4% vs. 20%, p=0.049), better BMI preservation, lower relapse rates (41.4% vs. 70%, p=0.027), and higher remission rates (58.6% vs. 30%, p=0.027).

Conclusions: Daily low-dose prednisolone appears more effective and safer than the standard alternate-day regimen in maintaining remission in children with FRNS.

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