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Background <p>Around half of children with steroid-sensitive nephrotic syndrome are eventually diagnosed with frequently relapsing or steroid-dependent disease. To minimize steroid toxicity, guidelines usually recommend switching these patients to steroid-sparing agents. Unfortunately, morbidity from steroids can be irreversible, and patients may suffer even after steroid discontinuation. </p> Methods <p>This is a multicenter observational study of children with steroid-sensitive nephrotic syndrome. We compared patients that were eventually diagnosed with frequently relapsing/steroid-dependent nephrotic syndrome with those with non/infrequently relapsing nephrotic syndrome. Additionally, we compared the risk of being diagnosed with frequently relapsing/steroid-dependent nephrotic syndrome, between patients with relapse on a prednisone dose equivalent of ≥ 0.5 mg/kg/every other day versus patients with no relapses above this cutoff. </p> Results <p>Patients who relapsed during induction were more likely to develop frequently relapsing/steroid-dependent nephrotic syndrome. Patients with ≥ 1 relapse on prednisone equivalent of ≥ 0.5 mg/kg/every other day were 33 times more likely to develop frequently relapsing/steroid-dependent nephrotic syndrome (<i>p</i> value &lt; 0.001). </p> Conclusions <p>Patients with one relapse on prednisone equivalent of ≥ 0.5 mg/kg/every other day are at high risk of an eventual diagnosis of frequently relapsing/steroid-dependent nephrotic syndrome. Further studies are needed to determine whether a single relapse above this cutoff is reliable enough to enable clinicians to switch patients to steroid-sparing agents before meeting formal criteria for frequently relapsing/steroid-dependent disease.</p> Graphical abstract <p></p>

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Single relapse at ≥ 0.5 mg/kg alternate-day prednisone predicts course of childhood nephrotic syndrome

  • 期刊论文

  • 发表日期：

    2026年2月6日

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  • Abigail A. Lazar,
  • Elena Zion,
  • Evgenia Gurevich,
  • Yael Borovitz,
  • Meital Keidar,
  • Roxana Cleper,
  • Orly Haskin,
  • Hadas Alfandary,
  • Daniella Levy-Erez,
  • Shelly Levi,
  • Gilad Hamdani,
  • Daniel Landau,
  • Amit Dagan

摘要

Background

Around half of children with steroid-sensitive nephrotic syndrome are eventually diagnosed with frequently relapsing or steroid-dependent disease. To minimize steroid toxicity, guidelines usually recommend switching these patients to steroid-sparing agents. Unfortunately, morbidity from steroids can be irreversible, and patients may suffer even after steroid discontinuation.

Methods

This is a multicenter observational study of children with steroid-sensitive nephrotic syndrome. We compared patients that were eventually diagnosed with frequently relapsing/steroid-dependent nephrotic syndrome with those with non/infrequently relapsing nephrotic syndrome. Additionally, we compared the risk of being diagnosed with frequently relapsing/steroid-dependent nephrotic syndrome, between patients with relapse on a prednisone dose equivalent of ≥ 0.5 mg/kg/every other day versus patients with no relapses above this cutoff.

Results

Patients who relapsed during induction were more likely to develop frequently relapsing/steroid-dependent nephrotic syndrome. Patients with ≥ 1 relapse on prednisone equivalent of ≥ 0.5 mg/kg/every other day were 33 times more likely to develop frequently relapsing/steroid-dependent nephrotic syndrome (p value < 0.001).

Conclusions

Patients with one relapse on prednisone equivalent of ≥ 0.5 mg/kg/every other day are at high risk of an eventual diagnosis of frequently relapsing/steroid-dependent nephrotic syndrome. Further studies are needed to determine whether a single relapse above this cutoff is reliable enough to enable clinicians to switch patients to steroid-sparing agents before meeting formal criteria for frequently relapsing/steroid-dependent disease.

Graphical abstract