Nephrotic syndrome (NS) is a common chronic renal disorder encountered in children. Idiopathic NS responds well to corticosteroid therapy with remission of proteinuria. A dose of 60 mg/m² body surface area per day of prednisolone is the recommendation for initial therapy of NS as per the International Study of Kidney Disease in Children (ISKDC) [1] and has been followed in several studies [2]. Several studies as well as Indian guidelines on management of steroid sensitive NS recommend 2 mg/kg body weight per day as initial starting dosage [3, 4]. Some authors recommend either body weight- based prednisolone or body surface area-based prednisolone regimen assuming both would be equivalent [5]. A recent study by Faber et al has shown that both the dosages are not equivalent as per cumulative dosing, especially when body weight is less than 30 kg and /or the total prednisolone dose is less than 60 mg/day; and recommended further studies to assess the clinical significance and outcome of children in response to both dosing in terms of time taken for remission, number of relapses and complications due to steroid therapy [6]. A retrospective study by Saadeh et al [7] has described the clinical effects of weight-based relative under dosing of prednisolone: while the initial response was not influenced by such under dosing, the frequency of relapses during the first 6 months appeared to be higher in this relatively under dosed group. They also recommended future prospective studies directly comparing outcomes of childhood NS with weight-based or body surface area-based dosing to confirm the findings of their study. Hence we propose to conduct the present randomized controlled trial to analyze the clinical significance of body weight-based prednisolone versus body surface area-based prednisolone regimen for induction of remission in children with NS.

REFERENCES

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