Authors: Sermin A Saadeh Rossana Baracco Amrish Jain Gaurav Kapur Tej K Mattoo Rudolph P Valentini
Publish Date: 2011/07/16
Volume: 26, Issue: 12, Pages: 2167-
Abstract
Although prednisone is the treatment of choice for nephrotic syndrome NS in childhood the dosing regimen varies between 60 mg/m2/day as recommended in early studies to the often prescribed 2 mg/kg/day dose which is used in common practice Mathematical models have demonstrated that weightbased dosing can be less than body surface area BSAbased dosing in smaller children To test our hypothesis that weightbased dosing would result in altered treatment outcomes in children with NS we analyzed a cohort of 56 children mean age 54 ± 38 years treated with a weightbased dosing regimen Theoretical underdosing of corticosteroids was tested by calculating a relative underdosing percentage RUP which was defined as the dose difference between the theoretical BSAbased dose and the actual weightbased doses divided by the BSAbased dose × 100 We found that the mean “actual” prednisone dose in our patients was 436 ± 193 mg/day in contrast the mean theoretical BSAbased dose was calculated to be 488 ± 167 mg/day Among the 56 patients 43 767 were initial responders of whom 58 followed a frequently relapsing FR course RUP was significantly higher in FR 166 ± 79 than in infrequent relapsers 87 ± 98 P = 003 RUP was not significantly different among initial responders and nonresponders Based on these results we conclude that prednisone underdosing when dosing is prescribed according to weight does not affect the initial response to treatment but it does increase the likelihood of a FR course in responders
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