2009

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{\phpg\posx1133\pvpg\posy874\absw3532\absh160 \i \f10 \fs14 \cf0 \i \f10 \fs14 \cf0
HK J Paediatr (new series){\i0 2009;}{\b\i0 14}{\i0 :103-107 }\par
}
{\phpg\posx1864\pvpg\posy2098\absw9272\absh1483 \f10 \fs32 \cf0 \f10 \fs32 \cf0
Long Versus Standard Course Corticosteroid Therapy
\par}{\phpg\posx1864\pvpg\posy2098\absw9272\absh1483 \sl-399 \f10 \fs32 \cf0
\fi1449 for Nephrotic Syndrome in Children
\par}{\phpg\posx1864\pvpg\posy2098\absw9272\absh1483 \sl-397 \par\f10 \fs32 \cf0
\fi3395 {\fs21 ALT}{\b\i \fs21 M }{\b\i\dn006 \fs15 A}{\b\i \fs21 ,}{\fs21 ETL}
{\b\i \fs21 S }{\b\i\dn006 \fs15 OO}{\b\i \fs21 ,}{\fs21 PC}{\b\i \fs21 T}
{\b\i\dn006 \fs15 ONG}{\b\i \fs21 ,}{\fs21 WM}{\b\i \fs21 L}{\b\i\dn006 \fs15
AI}{\b\i \fs21 ,}{\fs21 KC}{\b\i \fs21 T}{\b\i\dn006 \fs15 SE}{\b\i \fs21 ,}
{\fs21 MC}{\b\i \fs21 C}{\b\i\dn006 \fs15 HIU }\par
}
{\phpg\posx1133\pvpg\posy4558\absw1030\absh220 \b \f10 \fs19 \cf0 \b \f10 \fs19
\cf0 Abstract \par
}
\cf0 Key words \par
}
Steroid sensitive nephrotic syndrome (SSNS) is a common disease in childhood.
Although most children
respond to corticosteroid, relapse is a common problem. We aim to compare the
effect of 2-month steroid
treatment (standard course) according to International Study of Kidney Disease of
Children (ISKDC)
\par}{\phpg\posx2665\pvpg\posy4617\absw8509\absh2738 \sl-260 \f20 \fs18 \cf0 versus
6-month treatment (long course) on the clinical course of SSNS in a 1.5-year follow
up in our
centre. Medical records of patients seen from 1997-2006 were reviewed. A
total of 46 patients were
included in the study (standard course group=22, long course group=24). Patients
treated with long course
steroid had significantly lower relapse rate (33% versus 75%, p= 0.026) and higher
percentage of sustained
remission (p=0.0046) than that of standard course. None of our patients had
significant growth retardation
\par}{\phpg\posx2665\pvpg\posy4617\absw8509\absh2738 \sl-260 \f20 \fs18 \cf0 or
hypertension. Therefore, 6-month corticosteroid may be preferable to the standard
course for the initial
treatment of SSNS in children.
Corticosteroids; Relapses; Steroid sensitive nephrotic syndrome \par
}
\cf0 Introduction
\par}{\phpg\posx1133\pvpg\posy8205\absw4770\absh2521 \sl-259 \par\b \f10 \fs19 \cf0
\fi227 {\b0 \f20 \fs18 Nephrotic}{\b0 \f20 \fs18 syndrome}{\b0 \f20 \fs18 (NS)}
{\b0 \f20 \fs18 is}{\b0 \f20 \fs18 an}{\b0 \f20 \fs18 important}{\b0 \f20 \fs18
chronic}{\b0 \f20 \fs18 renal }
\par}{\phpg\posx1133\pvpg\posy8205\absw4770\absh2521 \sl-260 \b \f10 \fs19 \cf0
{\b0 \f20 \fs18 disease}{\b0 \f20 \fs18 in}{\b0 \f20 \fs18 childhood.}
{\b0\up006 \f20 \fs10 1}{\b0 \f20 \fs18 Minimal}{\b0 \f20 \fs18 change}{\b0 \f20
\fs18 disease}{\b0 \f20 \fs18 is}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 most }
{\b0 \f20 \fs18 commonly}{\b0 \f20 \fs18 found}{\b0 \f20 \fs18 histology}{\b0
\f20 \fs18 in}{\b0 \f20 \fs18 renal}{\b0 \f20 \fs18 biopsy.}{\b0\up006 \f20
\fs10 2}{\b0 \f20 \fs18 Although}{\b0 \f20 \fs18 most }
{\b0 \f20 \fs18 patients}{\b0 \f20 \fs18 respond}{\b0 \f20 \fs18 to}{\b0 \f20
\fs18 corticosteroids,}{\b0 \f20 \fs18 a}{\b0 \f20 \fs18 majority}{\b0 \f20
\fs18 of}{\b0 \f20 \fs18 patients }
{\b0 \f20 \fs18 relapse.}{\b0\up006 \f20 \fs10 2-4}{\b0 \f20 \fs18 It}{\b0 \f20
\fs18 has}{\b0 \f20 \fs18 been}{\b0 \f20 \fs18 suggested}{\b0 \f20 \fs18 that}
{\b0 \f20 \fs18 children}{\b0 \f20 \fs18 who}{\b0 \f20 \fs18 present }
{\b0 \f20 \fs18 with}{\b0 \f20 \fs18 a}{\b0 \f20 \fs18 young}{\b0 \f20 \fs18
age}{\b0 \f20 \fs18 at}{\b0 \f20 \fs18 onset}{\b0 \f20 \fs18 or}{\b0 \f20 \fs18
male}{\b0 \f20 \fs18 sex}{\b0 \f20 \fs18 were}{\b0 \f20 \fs18 more}{\b0 \f20
\fs18 likely}{\b0 \f20 \fs18 to }
{\b0 \f20 \fs18 have}{\b0 \f20 \fs18 relapses.}{\b0\up006 \f20 \fs10 5,6}{\b0
\f20 \fs18 Some}{\b0 \f20 \fs18 patients}{\b0 \f20 \fs18 may}{\b0 \f20 \fs18
require}{\b0 \f20 \fs18 prolonged }
{\b0 \f20 \fs18 courses}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 steroids}{\b0 \f20
\fs18 and}{\b0 \f20 \fs18 later}{\b0 \f20 \fs18 cytotoxic}{\b0 \f20 \fs18
agents}{\b0 \f20 \fs18 to}{\b0 \f20 \fs18 maintain }
{\b0 \f20 \fs18 remission. }{\b0\up006 \f20 \fs10 7}{\b0 \f20 \fs18 The}{\b0 \f20
\fs18 optimal}{\b0 \f20 \fs18 dose}{\b0 \f20 \fs18 and}{\b0 \f20 \fs18
duration}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 steroid}{\b0 \f20 \fs18
therapy }\par
}
{\phpg\posx6379\pvpg\posy8192\absw4875\absh2299 \f20 \fs18 \cf0 \f20 \fs18 \cf0 for
the treatment of NS in children have been investigated.{\up006 \fs10 1,8,9 }
\par}{\phpg\posx6379\pvpg\posy8192\absw4875\absh2299 \sl-260 \f20 \fs18 \cf0 Meta-
analysis has concluded that children in their first
episode of nephrotic syndrome should be treated for at least
\par}{\phpg\posx6379\pvpg\posy8192\absw4875\absh2299 \sl-260 \f20 \fs18 \cf0 three
months, with increased benefit up to seven months
\par}{\phpg\posx6379\pvpg\posy8192\absw4875\absh2299 \sl-260 \f20 \fs18 \cf0 post
treatment compared with 2-month therapy.{\up006 \fs10 1} We aimed
\par}{\phpg\posx6379\pvpg\posy8192\absw4875\absh2299 \sl-259 \f20 \fs18 \cf0 to
compare the effect of 2-month steroid treatment (standard
course) according to International Study of Kidney Disease
\par}{\phpg\posx6379\pvpg\posy8192\absw4875\absh2299 \sl-259 \f20 \fs18 \cf0 of
Children (ISKDC) versus 6-month treatment (long
course) on the clinical course of steroid sensitive nephrotic
syndrome (SSNS) in our centre.{\up006 \fs10 10 }\par
}
\cf0 Paediatric Nephrology Centre, Department of Paediatrics
\par}{\phpg\posx1133\pvpg\posy11772\absw4677\absh542 \sl-219 \b \f20 \fs16 \cf0 and
Adolescent Medicine, Princess Margaret Hospital,
\par}{\phpg\posx1133\pvpg\posy11772\absw4677\absh542 \sl-219 \b \f20 \fs16 \cf0 Lai
Chi Kok, Kowloon, Hong Kong SAR \par
}
ALT{\b M}{\b\dn006 \fs11 A }
\par}{\phpg\posx1133\pvpg\posy12538\absw753\absh1093 \sl-209 \f20 \fs16 \cf0 ETL{\b
S}{\b\dn006 \fs11 OO }
\par}{\phpg\posx1133\pvpg\posy12538\absw753\absh1093 \sl-209 \f20 \fs16 \cf0 PC{\b
T}{\b\dn006 \fs11 ONG }
\par}{\phpg\posx1133\pvpg\posy12538\absw753\absh1093 \sl-210 \f20 \fs16 \cf0 WM{\b
L}{\b\dn006 \fs11 AI }
\par}{\phpg\posx1133\pvpg\posy12538\absw753\absh1093 \sl-209 \f20 \fs16 \cf0 KC{\b
T}{\b\dn006 \fs11 SE }
\par}{\phpg\posx1133\pvpg\posy12538\absw753\absh1093 \sl-210 \f20 \fs16 \cf0 MC{\b
C}{\b\dn006 \fs11 HIU }\par
}
{\phpg\posx3004\pvpg\posy12552\absw2747\absh1075 \i \f20 \fs14 \cf0 \i \f20
\fs14 \cf0 MBBS (HK), DCH(HK), MRCPCH
\par}{\phpg\posx3004\pvpg\posy12552\absw2747\absh1075 \sl-209 \i \f20 \fs14 \cf0
MBBS (HK), DCH(HK)
MBBS(HK), MRCP, FHKPaed
MBBS(HK), FHKAM (Paed), FRCPaed
MBBS(HK), FHKCPaed(HK), FRCP(Edin)
MBBS(HK), FHKAM (Paed), FRCPCH \par
}
\cf0 Correspondence to:{\b0 Dr}{\b0 ALT} M{\dn006 \fs11 A }
{\b0\i \fs12 Received}{\b0\i \fs12 January}{\b0\i \fs12 12,}{\b0\i \fs12
2009 }\par
}
{\phpg\posx6379\pvpg\posy11325\absw4677\absh2754 \b \f10 \fs19 \cf0 \b \f10
\fs19 \cf0 Subjects and Methods
\par}{\phpg\posx6379\pvpg\posy11325\absw4677\absh2754 \sl-259 \par\b \f10 \fs19
\cf0 {\fs16 Patient}{\fs16 Data }
\fi226 {\b0 \f20 \fs18 The}{\b0 \f20 \fs18 data}{\b0 \f20 \fs18 was}{\b0
\f20 \fs18 collected}{\b0 \f20 \fs18 retrospectively}{\b0 \f20 \fs18 from}
{\b0 \f20 \fs18 medical }
{\b0 \f20 \fs18 records}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 children}{\b0 \f20
\fs18 presented}{\b0 \f20 \fs18 with}{\b0 \f20 \fs18 first}{\b0 \f20 \fs18
episode}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 SSNS }
{\b0 \f20 \fs18 seen}{\b0 \f20 \fs18 in}{\b0 \f20 \fs18 paediatric}{\b0 \f20
\fs18 nephrology}{\b0 \f20 \fs18 centre,}{\b0 \f20 \fs18 Princess}{\b0
\f20 \fs18 Margaret }
{\b0 \f20 \fs18 Hospital,}{\b0 \f20 \fs18 Hong}{\b0 \f20 \fs18 Kong}{\b0 \f20
\fs18 from}{\b0 \f20 \fs18 January}{\b0 \f20 \fs18 1997}{\b0 \f20 \fs18 till}
{\b0 \f20 \fs18 July}{\b0 \f20 \fs18 2006.}{\b0 \f20 \fs18 All }
{\b0 \f20 \fs18 records}{\b0 \f20 \fs18 were}{\b0 \f20 \fs18 reviewed}{\b0
\f20 \fs18 for}{\b0 \f20 \fs18 1.5}{\b0 \f20 \fs18 years}{\b0 \f20 \fs18 from}
{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 completion }
{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 steroid}{\b0 \f20 \fs18 treatment.}{\b0
\f20 \fs18 All}{\b0 \f20 \fs18 patients}{\b0 \f20 \fs18 were}{\b0 \f20 \fs18
treated}{\b0 \f20 \fs18 with}{\b0 \f20 \fs18 steroid }
{\b0 \f20 \fs18 alone.}{\b0 \f20 \fs18 We}{\b0 \f20 \fs18 have}{\b0 \f20 \fs18
excluded}{\b0 \f20 \fs18 patients}{\b0 \f20 \fs18 who}{\b0 \f20 \fs18 were}
{\b0 \f20 \fs18 previously }
{\b0 \f20 \fs18 treated,}{\b0 \f20 \fs18 those}{\b0 \f20 \fs18 who}{\b0 \f20
\fs18 suffered}{\b0 \f20 \fs18 from}{\b0 \f20 \fs18 steroid}{\b0 \f20 \fs18
resistant}{\b0 \f20 \fs18 disease }
{\b0 \f20 \fs18 (defined}{\b0 \f20 \fs18 as}{\b0 \f20 \fs18 failure}{\b0 \f20
\fs18 to}{\b0 \f20 \fs18 achieve}{\b0 \f20 \fs18 remission}{\b0 \f20 \fs18
with}{\b0 \f20 \fs18 4-week}{\b0 \f20 \fs18 course }\par
}
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0028a28a0028a28a0028a28a0028a28a0028a28a00fffd9
}}\par}{\phpg\posx850\pvpg\posy919\absw308\absh164 \f20 \fs18 \cf0 \f20 \fs18 \cf0
104 \par
}
{\phpg\posx7423\pvpg\posy906\absw3347\absh164 \f20 \fs18 \cf0 \f20 \fs18 \cf0 Long
Vs Standard course steroid in SSNS \par
}
{\phpg\posx850\pvpg\posy1724\absw4848\absh4861 \f20 \fs18 \cf0 \f20 \fs18 \cf0 of
60 mg/m{\up006 \fs10 2}/day prednisolone), those who were treated
\par}{\phpg\posx850\pvpg\posy1724\absw4848\absh4861 \sl-260 \f20 \fs18 \cf0 with
cytotoxic agents and those who defaulted follow ups
\par}{\phpg\posx850\pvpg\posy1724\absw4848\absh4861 \sl-260 \f20 \fs18 \cf0 in the
study period.
\par}{\phpg\posx850\pvpg\posy1724\absw4848\absh4861 \sl-259 \par\f20 \fs18 \cf0 {\b
\f10 \fs16 Outcome}{\b \f10 \fs16 Measures }
\par}{\phpg\posx850\pvpg\posy1724\absw4848\absh4861 \sl-259 \f20 \fs18 \cf0 \fi226
Percentage of patients with relapses, cumulative rate of
sustained remission, total number of relapses, and the height
standard deviation score (height SDS) before and after
treatment were compared.
\par}{\phpg\posx850\pvpg\posy1724\absw4848\absh4861 \sl-259 \par\f20 \fs18 \cf0 {\b
\f10 \fs16 Protocol}{\b \f10 \fs16 of}{\b \f10 \fs16 Prednisolone}{\b \f10 \fs16
Treatment}{\b \f10 \fs16 for}{\b \f10 \fs16 SSNS }
Our department employed the ISKDC 2-month
standard prednisolone regimen from year 1997 to 2001.{\up006 \fs10 10 }
(Prednisolone 60 mg/m{\up006 \fs10 2}/day for 4 weeks then 40 mg/m{\up006 \fs10
2}/
alternate day for 4 weeks) We have subsequently changed
\par}{\phpg\posx850\pvpg\posy1724\absw4848\absh4861 \sl-259 \f20 \fs18 \cf0 our
protocol to a 6-month regimen from 2002 till now.
(Prednisolone 60 mg/m{\up006 \fs10 2}/day for 4 weeks, then 40 mg/m{\up006 \fs10
2}/
alternate day for 4 weeks and slowly tapering off by 10 mg/m {\up006 \fs10 2}/
alternate day in four months, total course of 6 months)
\par}{\phpg\posx850\pvpg\posy1724\absw4848\absh4861 \sl-260 \f20 \fs18 \cf0 (Figure
1). Our patients were therefore conveniently divided
\par}{\phpg\posx850\pvpg\posy1724\absw4848\absh4861 \sl-259 \f20 \fs18 \cf0 into
standard course and long course group. \par
}
\cf0 Statistical Analysis
\fi227 {\b0 \f20 \fs18 Results}{\b0 \f20 \fs18 were}{\b0 \f20 \fs18 expressed}
{\b0 \f20 \fs18 as}{\b0 \f20 \fs18 mean}{\b0 \f40 \fs18 �}{\b0 \f20 \fs18
standard}{\b0 \f20 \fs18 deviation }
{\b0 \f20 \fs18 (SD).}{\b0 \f20 \fs18 Comparisons}{\b0 \f20 \fs18 between}
{\b0 \f20 \fs18 standard}{\b0 \f20 \fs18 and}{\b0 \f20 \fs18 long}{\b0
\f20 \fs18 course }
{\b0 \f20 \fs18 groups}{\b0 \f20 \fs18 were}{\b0 \f20 \fs18 made}{\b0 \f20
\fs18 using}{\b0\i \f20 \fs18 unpaired}{\b0\i \f20 \fs18 t}{\b0\i \f20 \fs18
tests}{\b0 \f20 \fs18 for}{\b0 \f20 \fs18 means}{\b0 \f20 \fs18 of }
{\b0 \f20 \fs18 quantitative}{\b0 \f20 \fs18 variables,}{\b0 \f20 \fs18 and}
{\b0\i \f20 \fs18 Chi-squared}{\b0 \f20 \fs18 or}{\b0\i \f20 \fs18 Fisher's}
{\b0\i \f20 \fs18 exact }
{\b0\i \f20 \fs18 test}{\b0 \f20 \fs18 for}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18
frequencies}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 qualitative}{\b0 \f20 \fs18
variables.}{\b0 \f20 \fs18 The }
{\b0 \f20 \fs18 cumulative}{\b0 \f20 \fs18 percentage}{\b0 \f20 \fs18 of}{\b0
\f20 \fs18 patients}{\b0 \f20 \fs18 with}{\b0 \f20 \fs18 sustained}{\b0 \f20
\fs18 remission }
{\b0 \f20 \fs18 was}{\b0 \f20 \fs18 demonstrated}{\b0 \f20 \fs18 by}{\b0\i
\f20 \fs18 Kaplan-Meier}{\b0 \f20 \fs18 curve.}{\b0 \f20 \fs18 The}{\b0 \f20
\fs18 height}{\b0 \f20 \fs18 SDS }
{\b0 \f20 \fs18 was}{\b0 \f20 \fs18 compared}{\b0 \f20 \fs18 at}{\b0 \f20 \fs18
the}{\b0 \f20 \fs18 beginning}{\b0 \f20 \fs18 and}{\b0 \f20 \fs18 end}{\b0
\f20 \fs18 of}{\b0 \f20 \fs18 treatment}{\b0 \f20 \fs18 with }
{\b0 \f20 \fs18 local}{\b0 \f20 \fs18 growth}{\b0 \f20 \fs18 reference.}
{\b0\up006 \f20 \fs10 11}{\b0 \f20 \fs18 All}{\b0 \f20 \fs18 statistical}{\b0
\f20 \fs18 analyses}{\b0 \f20 \fs18 were }
{\b0 \f20 \fs18 accomplished}{\b0 \f20 \fs18 using}{\b0 \f20 \fs18 the}{\b0
\f20 \fs18 Statistical}{\b0 \f20 \fs18 Package}{\b0 \f20 \fs18 for}{\b0 \f20
\fs18 the}{\b0 \f20 \fs18 Social }
{\b0 \f20 \fs18 Sciences}{\b0 \f20 \fs18 version}{\b0 \f20 \fs18 12.0}{\b0
\f20 \fs18 (SPSS}{\b0 \f20 \fs18 12.0).}{\b0 \f20 \fs18 Statistical}{\b0 \f20
\fs18 significance }
{\b0 \f20 \fs18 was}{\b0 \f20 \fs18 considered}{\b0 \f20 \fs18 at}{\b0 \f20 \fs18
the}{\b0 \f20 \fs18 value}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 p<0.05. }\par
}
{\phpg\posx850\pvpg\posy10275\absw709\absh146 \b \f20 \fs16 \cf0 \b \f20 \fs16 \cf0
Figure 1 \par
}
Standard and long course corticosteroid for treatment \par
}
SSNS in children. \par
}
\cf0 Definitions of Remission, Relapse and Steroid
Dependence
\fi226 {\b0 \f20 \fs18 Remission}{\b0 \f20 \fs18 was}{\b0 \f20 \fs18 defined}
{\b0 \f20 \fs18 as}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 disappearance}{\b0
\f20 \fs18 of }
{\b0 \f20 \fs18 proteinuria}{\b0 \f20 \fs18 for}{\b0 \f20 \fs18 at}{\b0 \f20
\fs18 least}{\b0 \f20 \fs18 three}{\b0 \f20 \fs18 consecutive}{\b0 \f20 \fs18
days}{\b0\up006 \f20 \fs10 1}{\b0 \f20 \fs18 (urinary }
{\b0 \f20 \fs18 excretion}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 protein}{\b0 \f20
\fs18 <4}{\b0 \f20 \fs18 mg/m}{\b0\up006 \f20 \fs10 2}{\b0 \f20 \fs18 /hr}
{\b0 \f20 \fs18 or}{\b0 \f20 \fs18 negative}{\b0 \f20 \fs18 to}{\b0 \f20 \fs18
trace}{\b0 \f20 \fs18 from }
{\b0 \f20 \fs18 urine}{\b0 \f20 \fs18 dipstick}{\b0 \f20 \fs18 test).}{\b0
\f20 \fs18 Relapse}{\b0 \f20 \fs18 was}{\b0 \f20 \fs18 defined}{\b0 \f20 \fs18
as}{\b0 \f20 \fs18 a}{\b0 \f20 \fs18 reappearance }
{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 proteinuria}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18
2+}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 more}{\b0 \f20 \fs18 continued}{\b0
\f20 \fs18 for}{\b0 \f20 \fs18 3}{\b0 \f20 \fs18 consecutive }
{\b0 \f20 \fs18 days}{\b0\up006 \f20 \fs10 1}{\b0 \f20 \fs18 (urinary}{\b0
\f20 \fs18 excretion}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 protein}{\b0 \f20
\fs18 >=40}{\b0 \f20 \fs18 mg/m}{\b0\up006 \f20 \fs10 2}{\b0 \f20 \fs18
/hr). }
{\b0 \f20 \fs18 Relapse}{\b0 \f20 \fs18 was}{\b0 \f20 \fs18 treated}{\b0 \f20
\fs18 with}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 daily}{\b0 \f20 \fs18
prednisolone}{\b0 \f20 \fs18 does}{\b0 \f20 \fs18 of }
{\b0 \f20 \fs18 60}{\b0 \f20 \fs18 mg/m }{\b0\up006 \f20 \fs10 2}{\b0 \f20
\fs18 /}{\b0 \f20 \fs18 day}{\b0 \f20 \fs18 until}{\b0 \f20 \fs18 urine}{\b0
\f20 \fs18 protein}{\b0 \f20 \fs18 became}{\b0 \f20 \fs18 negative}{\b0 \f20
\fs18 for}{\b0 \f20 \fs18 three }
{\b0 \f20 \fs18 consecutive}{\b0 \f20 \fs18 days,}{\b0 \f20 \fs18 followed}
{\b0 \f20 \fs18 by}{\b0 \f20 \fs18 40}{\b0 \f20 \fs18 mg/m}{\b0\up006 \f20 \fs10
2}{\b0 \f20 \fs18 /alternate}{\b0 \f20 \fs18 day}{\b0 \f20 \fs18 for }
{\b0 \f20 \fs18 4}{\b0 \f20 \fs18 weeks. }\par
}
\cf0 Results
\fi227 {\b0 \f20 \fs18 A}{\b0 \f20 \fs18 total}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18
46}{\b0 \f20 \fs18 patients}{\b0 \f20 \fs18 were}{\b0 \f20 \fs18 included}
{\b0 \f20 \fs18 in}{\b0 \f20 \fs18 our}{\b0 \f20 \fs18 study.}{\b0 \f20 \fs18
Their }
{\b0 \f20 \fs18 age}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 presentation}{\b0 \f20
\fs18 ranged}{\b0 \f20 \fs18 from}{\b0 \f20 \fs18 2.1}{\b0 \f20 \fs18 to}
{\b0 \f20 \fs18 15.1}{\b0 \f20 \fs18 years.}{\b0 \f20 \fs18 There }
{\b0 \f20 \fs18 were}{\b0 \f20 \fs18 32}{\b0 \f20 \fs18 boys}{\b0 \f20 \fs18
(68.1%)}{\b0 \f20 \fs18 and}{\b0 \f20 \fs18 14}{\b0 \f20 \fs18 girls}{\b0
\f20 \fs18 (29.8%).}{\b0 \f20 \fs18 The}{\b0 \f20 \fs18 standard }
{\b0 \f20 \fs18 course}{\b0 \f20 \fs18 group}{\b0 \f20 \fs18 consisted}{\b0
\f20 \fs18 of}{\b0 \f20 \fs18 22}{\b0 \f20 \fs18 patients}{\b0 \f20 \fs18
(mean}{\b0 \f20 \fs18 age}{\b0 \f20 \fs18 of }
{\b0 \f20 \fs18 5.12,}{\b0 \f20 \fs18 Male}{\b0 \f20 \fs18 to}{\b0 \f20 \fs18
female}{\b0 \f20 \fs18 ratio=17:5).}{\b0 \f20 \fs18 Long}{\b0 \f20 \fs18
course}{\b0 \f20 \fs18 group }
{\b0 \f20 \fs18 consisted}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 24}{\b0 \f20 \fs18
patients}{\b0 \f20 \fs18 (mean}{\b0 \f20 \fs18 age}{\b0 \f20 \fs18 of}{\b0
\f20 \fs18 6.29,}{\b0 \f20 \fs18 male}{\b0 \f20 \fs18 to }
{\b0 \f20 \fs18 female}{\b0 \f20 \fs18 ratio=15:9).}{\b0 \f20 \fs18 There}{\b0
\f20 \fs18 was}{\b0 \f20 \fs18 no}{\b0 \f20 \fs18 significant}{\b0 \f20 \fs18
difference }
{\b0 \f20 \fs18 between}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 two}{\b0 \f20 \fs18
groups}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 patients}{\b0 \f20 \fs18 in}{\b0
\f20 \fs18 terms}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 number, }
{\b0 \f20 \fs18 age}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 disease}{\b0 \f20 \fs18
onset,}{\b0 \f20 \fs18 sex}{\b0 \f20 \fs18 ratio,}{\b0 \f20 \fs18 and}{\b0
\f20 \fs18 serum}{\b0 \f20 \fs18 parameters }
{\b0 \f20 \fs18 (Table}{\b0 \f20 \fs18 1). }
\fi227 {\b0 \f20 \fs18 Patients}{\b0 \f20 \fs18 treated}{\b0 \f20 \fs18 with}
{\b0 \f20 \fs18 standard}{\b0 \f20 \fs18 course}{\b0 \f20 \fs18 steroid}
{\b0 \f20 \fs18 had }
{\b0 \f20 \fs18 significantly}{\b0 \f20 \fs18 higher}{\b0 \f20 \fs18 relapse}{\b0
\f20 \fs18 rate}{\b0 \f20 \fs18 at}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 end}{\b0
\f20 \fs18 of}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 study}{\b0 \f20 \fs18 (75% }
{\b0 \f20 \fs18 vs}{\b0 \f20 \fs18 33%,}{\b0 \f20 \fs18 p=0.026).}{\b0 \f20 \fs18
Only}{\b0 \f20 \fs18 six}{\b0 \f20 \fs18 patients}{\b0 \f20 \fs18 in}{\b0
\f20 \fs18 the}{\b0 \f20 \fs18 standard}{\b0 \f20 \fs18 course }
{\b0 \f20 \fs18 group}{\b0 \f20 \fs18 never}{\b0 \f20 \fs18 relapsed}{\b0 \f20
\fs18 while}{\b0 \f20 \fs18 fifteen}{\b0 \f20 \fs18 patients}{\b0 \f20 \fs18
never}{\b0 \f20 \fs18 relapsed }
{\b0 \f20 \fs18 in}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 long}{\b0 \f20 \fs18
course}{\b0 \f20 \fs18 group.}{\b0 \f20 \fs18 The}{\b0 \f20 \fs18 percentage}
{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 patients}{\b0 \f20 \fs18 who }
{\b0 \f20 \fs18 remained}{\b0 \f20 \fs18 in}{\b0 \f20 \fs18 sustained}{\b0
\f20 \fs18 remission}{\b0 \f20 \fs18 is}{\b0 \f20 \fs18 significantly}{\b0
\f20 \fs18 higher}{\b0 \f20 \fs18 in }
{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 long}{\b0 \f20 \fs18 course}{\b0 \f20 \fs18
group}{\b0 \f20 \fs18 than}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 standard}
{\b0 \f20 \fs18 course}{\b0 \f20 \fs18 group }
{\b0 \f20 \fs18 (log}{\b0 \f20 \fs18 rank}{\b0 \f20 \fs18 value=8.03,}{\b0
\f20 \fs18 p=0.0046)}{\b0 \f20 \fs18 (Figure}{\b0 \f20 \fs18 1).}{\b0 \f20 \fs18
Although}{\b0 \f20 \fs18 the }
{\b0 \f20 \fs18 number}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 relapses}{\b0 \f20
\fs18 during}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 follow}{\b0 \f20 \fs18 up}{\b0
\f20 \fs18 period}{\b0 \f20 \fs18 (per}{\b0 \f20 \fs18 patient }
{\b0 \f20 \fs18 per}{\b0 \f20 \fs18 year)}{\b0 \f20 \fs18 did}{\b0 \f20 \fs18
not}{\b0 \f20 \fs18 differ}{\b0 \f20 \fs18 significantly}{\b0 \f20 \fs18
between}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18 two}{\b0 \f20 \fs18 groups, }
{\b0 \f20 \fs18 patients}{\b0 \f20 \fs18 from}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18
standard}{\b0 \f20 \fs18 course}{\b0 \f20 \fs18 group}{\b0 \f20 \fs18 were}
{\b0 \f20 \fs18 more}{\b0 \f20 \fs18 likely }
{\b0 \f20 \fs18 to}{\b0 \f20 \fs18 relapse}{\b0 \f20 \fs18 more}{\b0 \f20 \fs18
than}{\b0 \f20 \fs18 once}{\b0 \f20 \fs18 in}{\b0 \f20 \fs18 the}{\b0 \f20 \fs18
study}{\b0 \f20 \fs18 period}{\b0 \f20 \fs18 (p=0.017). }
{\b0 \f20 \fs18 None}{\b0 \f20 \fs18 of}{\b0 \f20 \fs18 our}{\b0 \f20 \fs18
patients}{\b0 \f20 \fs18 was}{\b0 \f20 \fs18 on}{\b0 \f20 \fs18 anti-
hypertensive}{\b0 \f20 \fs18 agents.}{\b0 \f20 \fs18 No }
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4967ec01ff008991fb3aff00f3c6afbfe8a00f803fe1ec5ff04b2ffa4967ec01ff008991fb3aff00f3c
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7ec01ff8991fb3afff003c6a3fe1ec5ff04b2ffa4967ec01ff008991fb3aff00f3c6afbfe8a00f803fe
1ec5ff04b2ffa4967ec01ff008991fb3aff00f3c6a3fe1ec5ff0004b2ff00a4967ec01ff8991fb3afff
003c6afbfe8a00f803fe1ec5ff0004b2ff00a4967ec01ff8991fb3afff003c6a3fe1ec5ff04b2ffa496
7ec01ff008991fb3aff00f3c6afbfe8a00f803fe1ec5ff04b2ffa4967ec01ff008991fb3aff00f3c6a3
fe1ec5ff0004b2ff00a4967ec01ff8991fb3afff003c6afbfe8a00f803fe1ec5ff0004b2ff00a4967ec
01ff8991fb3afff003c6a3fe1ec5ff04b2ffa4967ec01ff008991fb3aff00f3c6afbfe8a00f803fe1ec
5ff04b2ffa4967ec01ff008991fb3aff00f3c6a3fe1ec5ff0004b2ff00a4967ec01ff8991fb3afff003
c6afbfe8a00f803fe1ec5ff0004b2ff00a4967ec01ff8991fb3afff003c6a3fe1ec5ff04b2ffa4967ec
01ff008991fb3aff00f3c6afbfe8a00f803fe1ec5ff04b2ffa4967ec01ff008991fb3aff00f3c6a3fe1
ec5ff0004b2ff00a4967ec01ff8991fb3afff003c6afbfe8a00f803fe1ec5ff0004b2ff00a4967ec01f
f8991fb3afff003c6a3fe1ec5ff04b2ffa4967ec01ff008991fb3aff00f3c6afbfe8a00f803fe1ec5ff
04b2ffa4967ec01ff008991fb3aff00f3c6a3fe1ec5ff0004b2ff00a4967ec01ff8991fb3afff003c6a
fbfe8a00f803fe1ec5ff0004b2ff00a4967ec01ff8991fb3afff003c6a3fe1ec5ff04b2ffa4967ec01f
f008991fb3aff00f3c6afbfe8a00f803fe1ec5ff04b2ffa4967ec01ff008991fb3aff00f3c6a3fe1ec5
ff0004b2ff00a4967ec01ff8991fb3afff003c6afbfe8a00f803fe1ec5ff0004b2ff00a4967ec01ff89
91fb3afff003c6a3fe1ec5ff04b2ffa4967ec01ff008991fb3aff00f3c6afbfe8a00f803fe1ec5ff04b
2ffa4967ec01ff008991fb3aff00f3c6a3fe1ec5ff0004b2ff00a4967ec01ff8991fb3afff003c6afbf
e8a00f803fe1ec5ff0004b2ff00a4967ec01ff8991fb3afff003c6a3fe1ec5ff04b2ffa4967ec01ff00
8991fb3aff00f3c6afbfe8a00f803fe1ec5ff04b2ffa4967ec01ff008991fb3aff00f3c6afb7fc27e2c
f0af8f7c2be19f1d7817c4de1ff001a7827c69e1fd1bc59e0ef18f84f59d3bc47e15f167857c47a75b6
b1e1ef137867c43a3dcde691af787f5dd22f2cf54d1b59d2ef2eb4ed534ebab6beb1b99eda78a56e828
8a28a0028a28a0028a28a002be20f167ed5ff001e7c39e2af13787b47ff008264fedbfe3dd2341f106b
3a3697e3af09f8fbfe09b767e15f1a69da5ea3736363e2cf0cd9f8ebfe0a0de0bf1b5af87fc476d045a
c68d6de31f07784fc55069d796d17887c33a16aeb79a5dafdbf45007c01ff000d91fb457fd2277f6fff
00fc38dff04b2ffe99651ff0d91fb457fd2277f6ff00ff00c38dff0004b2ff00e99657dff45007c01ff
0d91fb457fd2277f6ff00ff00c38dff0004b2ff00e99651ff000d91fb457fd2277f6fff00fc38dff04b
2ffe99657dff0045007c01ff000d91fb457fd2277f6fff00fc38dff04b2ffe99651ff0d91fb457fd227
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99657dff45007c01ff0d91fb457fd2277f6ff00ff00c38dff0004b2ff00e99651ff000d91fb457fd227
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51450014514500145145001451450014514500145145001451450014514500145145001451450014514
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500145145001451450014514500145145007ffd9
Ma et al \par
}
105 \par
}
Table 1 \par
}
Clinical and laboratory characteristics of patients
{\b Standard}{\b course }\par
}
{\phpg\posx1133\pvpg\posy2360\absw2005\absh1289 \f20 \fs16 \cf0 \f20 \fs16 \cf0 No
of patients (n)
\par}{\phpg\posx1133\pvpg\posy2360\absw2005\absh1289 \sl-316 \f20 \fs16 \cf0 M/F
\par}{\phpg\posx1133\pvpg\posy2360\absw2005\absh1289 \sl-316 \f20 \fs16 \cf0 Age
\par}{\phpg\posx1133\pvpg\posy2360\absw2005\absh1289 \sl-316 \f20 \fs16 \cf0 Serum
Albumin (g/dl)
\par}{\phpg\posx1133\pvpg\posy2360\absw2005\absh1289 \sl-317 \f20 \fs16 \cf0 Serum
creatinine (umol/L ) \par
}
{\phpg\posx4534\pvpg\posy2360\absw790\absh1302 \f20 \fs16 \cf0 \f20 \fs16 \cf0 22
\par}{\phpg\posx4534\pvpg\posy2360\absw790\absh1302 \sl-316 \f20 \fs16 \cf0 17/5
5.12{\f40 �}3.18
15.5{\f40 �}2.41
42.5{\f40 �}12.5 \par
}
\cf0 Long course
\par}{\phpg\posx7367\pvpg\posy2043\absw963\absh1587 \sl-316 \b \f20 \fs16 \cf0 {\b0
24 }
15/9 }
6.92}{\b0 �}{\b0 5.57 }
15.6}{\b0 \f40 �}{\b0 4.01 }
47.1}{\b0 \f40 �}{\b0 18 }\par
}
\cf0 Significance
{\b0 Not}{\b0 significant }
{\b0 Not}{\b0 significant }\par
}
Table 2 \par
}
{\phpg\posx1984\pvpg\posy4513\absw4609\absh403 \f20 \fs16 \cf0 \f20 \fs16 \cf0 Data
comparison between the standard and long course groups
{\b Standard}{\b course}{\b (N=22) }\par
}
{\phpg\posx1133\pvpg\posy5116\absw2358\absh1575 \f20 \fs16 \cf0 \f20 \fs16 \cf0 No.
of patients without relapse
\par}{\phpg\posx1133\pvpg\posy5116\absw2358\absh1575 \sl-316 \f20 \fs16 \cf0 No. of
patients with relapses
\par}{\phpg\posx1133\pvpg\posy5116\absw2358\absh1575 \sl-316 \f20 \fs16 \cf0 No. of
patients with >1 relapses
\par}{\phpg\posx1133\pvpg\posy5116\absw2358\absh1575 \sl-317 \f20 \fs16 \cf0 Height
SDS score
\par}{\phpg\posx1133\pvpg\posy5116\absw2358\absh1575 \sl-316 \f20 \fs16 \cf0 Before
steroid treatment
\par}{\phpg\posx1133\pvpg\posy5116\absw2358\absh1575 \sl-316 \f20 \fs16 \cf0 After
steroid treatment \par
}
{\phpg\posx4535\pvpg\posy5116\absw731\absh718 \f20 \fs16 \cf0 \f20 \fs16 \cf0 6
\par}{\phpg\posx4535\pvpg\posy5116\absw731\absh718 \sl-316 \f20 \fs16 \cf0 16 (75%)
\par}{\phpg\posx4535\pvpg\posy5116\absw731\absh718 \sl-316 \f20 \fs16 \cf0 15 \par

}
\cf0 Long course (N=24)
{\b0 15 }
{\b0 9}{\b0 (33%) }
{\b0 5 }\par
}
\cf0 Significance
P=0.026
P=0.026
P=0.017 \par
}
1.1{\f40 �}3.5
\par}{\phpg\posx4537\pvpg\posy6328\absw695\absh496 \sl-316 \f20 \fs16 \cf0 0.8{\f40
�}1.54 \par
}
0.5{\f40 �}1.1
0.27{\f40 �}1.04 \par
}
{\phpg\posx9919\pvpg\posy6384\absw1096\absh148 \f20 \fs16 \cf0 \f20 \fs16 \cf0 Not
significant \par
}
Table 3 \par
}
Influence of the absence of relapses on further course of SSNS
{\b No.}{\b and}{\b %}{\b of}{\b patients}{\b who}{\b relapse}{\b in}{\b
the}{\b following}{\b post}{\b treatment}{\b periods }\par
}
Course of disease \par
}
\cf0 First 6m after treatment \par
}
No.
{\b0 20/46 }
26/46 }\par
}
{\phpg\posx5588\pvpg\posy8509\absw393\absh740 \b \f20 \fs16 \cf0 \fi184 \b \f20
\fs16 \cf0 %
43%
56% \par
}
\cf0 Next 6 to 12m after treatment \par
}
No.
{\b0 13/20 }
7/26 }\par
}
{\phpg\posx8988\pvpg\posy8509\absw393\absh740 \b \f20 \fs16 \cf0 \fi185 \b \f20
\fs16 \cf0 %
65%
27% \par
}
Children with relapse(s)
Children without relapse \par
}
within the first 6 months after completing the initial therapy.
Thirteen of these 20 children (65% of those who relapsed
\par}{\phpg\posx1133\pvpg\posy10323\absw4706\absh2271 \sl-260 \f20 \fs18 \cf0 in
the first 6 months) had further relapse in the next 6-12
months. On the other hand, for the remaining 26 patients
\par}{\phpg\posx1133\pvpg\posy10323\absw4706\absh2271 \sl-260 \f20 \fs18 \cf0 who
did not relapse (57% of the total study population),
\par}{\phpg\posx1133\pvpg\posy10323\absw4706\absh2271 \sl-259 \f20 \fs18 \cf0 only
seven relapsed in the next 6-12 months (27% of those
\par}{\phpg\posx1133\pvpg\posy10323\absw4706\absh2271 \sl-260 \f20 \fs18 \cf0 who
did not relapse in the first 6 months) (Odds ratio 5.04,
\par}{\phpg\posx1133\pvpg\posy10323\absw4706\absh2271 \sl-260 \f20 \fs18 \cf0 95%
confidence interval 1.42-17.8). Therefore, patients
\par}{\phpg\posx1133\pvpg\posy10323\absw4706\absh2271 \sl-259 \f20 \fs18 \cf0 with
relapse within the first six months after initial therapy
\par}{\phpg\posx1133\pvpg\posy10323\absw4706\absh2271 \sl-260 \f20 \fs18 \cf0 were
more likely to relapse in the next 6-12 months. \par
}
children are responsive to steroid therapy, over 70% of
patients with SSNS subsequently relapse.{\up006 \fs10 1,12} In our cohort,
\par}{\phpg\posx6379\pvpg\posy10323\absw4798\absh3674 \sl-260 \f20 \fs18 \cf0 up to
75% of patients in the standard course group relapsed.
\par}{\phpg\posx6379\pvpg\posy10323\absw4798\absh3674 \sl-259 \f20 \fs18 \cf0 This
result could be related to the limitations of this study
\par}{\phpg\posx6379\pvpg\posy10323\absw4798\absh3674 \sl-260 \f20 \fs18 \cf0 and
will be discussed later. Nevertheless, we were able to
demonstrate that nephrotic children who were treated with
\par}{\phpg\posx6379\pvpg\posy10323\absw4798\absh3674 \sl-260 \f20 \fs18 \cf0 long
course steroid therapy had fewer relapses, and were
\par}{\phpg\posx6379\pvpg\posy10323\absw4798\absh3674 \sl-260 \f20 \fs18 \cf0 more
likely to remain in remission (Figure 2). Our findings
\par}{\phpg\posx6379\pvpg\posy10323\absw4798\absh3674 \sl-259 \f20 \fs18 \cf0 are
consistent with the previous work showing an inverse
relation between the risk of relapse and the duration of
corticosteroids therapy.{\up006 \fs10 1,3,13-17} Therefore, many centres now
recommend steroid treatment of at least 12 weeks for better
patient outcome.{\up006 \fs10 3,16-17} The optimal protocol to treat SSNS,
more so relapsing SSNS, is yet to be defined and studies
\par}{\phpg\posx6379\pvpg\posy10323\absw4798\absh3674 \sl-260 \f20 \fs18 \cf0 are
underway.{\up006 \fs10 5,9} Hopefully, more detailed approach will
\par}{\phpg\posx6379\pvpg\posy10323\absw4798\absh3674 \sl-259 \f20 \fs18 \cf0 be
available in the near future. \par
}
\cf0 Discussion
\fi227 {\b0 \f20 \fs18 Corticosteroid}{\b0 \f20 \fs18 has}{\b0 \f20 \fs18 been}
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07fffd9
106 \par
}
{\phpg\posx7423\pvpg\posy906\absw3347\absh164 \f20 \fs18 \cf0 \f20 \fs18 \cf0 Long
Vs Standard course steroid in SSNS \par
}
those who did not. It remains, however, unclear if the
beneficial effect of long course is solely related to the
extended duration of immunosuppression.{\up006 \fs10 13} Apart from
\par}{\phpg\posx6094\pvpg\posy1743\absw4916\absh11163 \sl-259 \f20 \fs18 \cf0 early
relapse after disease onset, the duration of remission
period immediately before the most recent relapse was also
described to be a risk factor for prediction of relapse.{\up006 \fs10 17 }
Patients having both risk factors may be more likely to have
relapsing disease, and hence earlier treatment with
immunosuppressants could be considered in selected cases.{\up006 \fs10 17 }
\fi227 One interesting observation was the great difference
between the survival curves of the two groups. This may
\par}{\phpg\posx6094\pvpg\posy1743\absw4916\absh11163 \sl-260 \f20 \fs18 \cf0 be an
over presentation and deserves explanation. In terms
patients' clinical characteristics, although their serum
albumin and creatinine levels showed no significant
difference between the two groups, there could still be
difference in their disease severity to start with. Limited by
\par}{\phpg\posx6094\pvpg\posy1743\absw4916\absh11163 \sl-260 \f20 \fs18 \cf0 the
retrospective nature of the study, laboratory parameters
\par}{\phpg\posx6094\pvpg\posy1743\absw4916\absh11163 \sl-260 \f20 \fs18 \cf0 such
as initial cholesterol level, 24 hour urine protein level,
creatinine clearance were not well documented and
therefore no valid statistical analysis could be carried out
compare the two groups of patients. In terms of
management practice, despite the presence of a standard
steroid protocol in the department, different physicians may
\par}{\phpg\posx6094\pvpg\posy1743\absw4916\absh11163 \sl-259 \f20 \fs18 \cf0 have
their own preference on dosage adjustments. This
contributed to the difference in total cumulative dose of
steroids given to patients and hence their outcomes. The
failure to document patient's compliance to treatment was
another limitation of the study. Therefore, despite the
significant findings, we believe that the two groups of
patients may represent patients with dissimilar severity of
nephrotic syndrome which took cautions to compare.
\fi227 There are certain limitations to our study. As mentioned,
\par}{\phpg\posx6094\pvpg\posy1743\absw4916\absh11163 \sl-260 \f20 \fs18 \cf0 being
a retrospective study, data collection was incomplete
\par}{\phpg\posx6094\pvpg\posy1743\absw4916\absh11163 \sl-259 \f20 \fs18 \cf0 in
some areas. Second, the sample size is relatively small
patient recruitment was not randomised. Moreover, all
data was obtained from a single centre and hence more
\par}{\phpg\posx6094\pvpg\posy1743\absw4916\absh11163 \sl-259 \f20 \fs18 \cf0 prone
to bias. Patients were recruited from different periods
time, and it was not known if there was change in the
histopathological heterogeneity of children with nephrotic
syndrome over the years which may contribute to the
difference in response to steroid therapy. Last but not least,
follow up period was short and the duration of sustained
remission after steroid treatment could not be accurately
projected. All these factors may result in bias and should
\par}{\phpg\posx6094\pvpg\posy1743\absw4916\absh11163 \sl-260 \f20 \fs18 \cf0 be
taken into consideration.
\fi227 In conclusion, with the limitations and constraints in
\par}{\phpg\posx6094\pvpg\posy1743\absw4916\absh11163 \sl-259 \f20 \fs18 \cf0 mind,
the 6-month corticosteroid therapy is more likely to
provide better rate of sustained remission when compared \par
}
Figure 2 \par
}
Cumulative rate of children with sustained remission \par
}
long course (black line with triangle) vs standard course (grey
\par}{\phpg\posx850\pvpg\posy5843\absw4677\absh399 \sl-279 \f20 \fs16 \cf0 line
with square) steroid therapy. \par
}
{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \f20 \fs18 \cf0 \fi226 \f20 \fs18
\cf0 Steroid is not without side effects. Obesity, striae,
hirsutism, osteoporosis, psychiatric disturbances, and
cataract are some of the common side effects.{\up006 \fs10 13} The
occurrence of steroidal side-effects was only partly
addressed by this study because of its retrospective nature
incomplete documentation of data. We were only able
conclude that none of our patients in this cohort was on
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-260 \f20 \fs18 \cf0 anti-
hypertensive agents, and there was no significant
difference between the pre and post steroid height SDS in
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-260 \f20 \fs18 \cf0 each
study group. The degree of steroid toxicity was shown
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-260 \f20 \fs18 \cf0 to be
proportional to the dose and duration of treatment.{\up006 \fs10 7,18 }
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-259 \f20 \fs18 \cf0 Hodson
et al commented that six-month therapy results in
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-260 \f20 \fs18 \cf0 less
relapse without increase in adverse effects in
comparison to three-month therapy.{\up006 \fs10 1,18} This view was
supported by various authors.{\up006 \fs10 8,13} It was opined that the side
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-260 \f20 \fs18 \cf0 effects
of steroids were reversible or mild if further
treatment courses were rarely required subsequently. {\up006 \fs10 13} After
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-260 \f20 \fs18 \cf0 all,
physicians must judge clinically and take the balance
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-259 \f20 \fs18 \cf0 between
better relapse control and steroid toxicities.
According to APN (Arbeitsgemeinschaft fur Padiatrische
Nephrologie) report in 1988, the percentage of patients with
frequent relapses in the first 6 months after cessation of
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-260 \f20 \fs18 \cf0 steroid
was higher with the standard course regimen (61%)
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-259 \f20 \fs18 \cf0 than
the long course regimen (31%).{\up006 \fs10 16} Similar results were
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-260 \f20 \fs18 \cf0 shown
by Ueda et al and Ehrich & Brodehl in 1988 and
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-260 \f20 \fs18 \cf0 1992
respectively.{\up006 \fs10 7,13} Our results and theirs suggested that
children with relapse early in their illness continue to have
\par}{\phpg\posx850\pvpg\posy6943\absw4813\absh6483 \sl-260 \f20 \fs18 \cf0 a
stronger tendency to relapse throughout their illness than \par
}
ffd8ffe000104a46494600010100000100010000ffdb004300010101010101010101010101010101010
10101010101010101010101010101010101010101010101010101010101010101010101010101010101
010101010101ffdb0043010101010101010101010101010101010101010101010101010101010101010
1010101010101010101010101010101010101010101010101010101010101010101ffc0001108030c02
5303012200021101031101ffc4001f00000105010101010101000000000000000001020304050607080
90a0bffc400b5100002010303020403050504040000017d010203000411051221314106135161072271
14328191a1082342b1c11552d1f02433627282090a161718191a25262728292a3435363738393a43444
5464748494a535455565758595a636465666768696a737475767778797a838485868788898a92939495
0102030405060708090a0bffc400b511000201020404030407050404000102770001020311040521310
61241510761711322328108144291a1b1c109233352f0156272d10a162434e125f11718191a26272829
2a35363738393a434445464748494a535455565758595a636465666768696a737475767778797a82838
0028a28a0028a28a0028a28a0028a28a0028a28
28a00ffd9
Ma et al \par
}
107 \par
}
{\phpg\posx1133\pvpg\posy1743\absw4689\absh1101 \f20 \fs18 \cf0 \f20 \fs18 \cf0 to
the standard ISKDC regimen as the initial management
first episode SSNS. This pilot study sets the scene for
\par}{\phpg\posx1133\pvpg\posy1743\absw4689\absh1101 \sl-260 \f20 \fs18 \cf0 future
studies to further examine the implication of duration
corticosteroids on the clinical course of nephrotic
syndrome in children. \par
}
{\phpg\posx6379\pvpg\posy1731\absw158\absh140 \f20 \fs15 \cf0 \f20 \fs15 \cf0 9.
\par
}
Hiraoka M TH, Matsubara K, Tsurusawa M, et al. A randomised
\par}{\phpg\posx6718\pvpg\posy1731\absw4386\absh518 \sl-210 \f20 \fs15 \cf0 study
of Two long courses predinisolone regimens for nephrotic
syndrome in children. Am J Kidney Dis 2003;41:1156-62. \par
}
\cf0 References \par
}
\par
}
\par}{\phpg\posx1133\pvpg\posy4661\absw158\absh896 \sl-210 \par\f20 \fs15 \cf0 3.
4. \par
}
\par
}
\par
}
\par
}
\par
}
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higher initial prednisolone therapy for nephrotic syndrome.
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West Japan Cooperative Study of Kidney Disease in
Children. Kidney Int 2002;58:1247-52.
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MA, Baildom EM, Davis N, Houston IB, Postlethwaite
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N, Chihara M, Kawaguchi S, et al. Intermittent versus long-
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tapering prednisolone for initial therapy in children with
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treatment in steroid-sensitive nephrotic syndrome in children.
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Paediatr 1995;84:889-93. \par
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94. \par
}
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