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Kidney Week

Abstract: FR-PO1124

Lower Doses of Prednisolone Are Sufficient for Initial Treatment in Adult-Onset Minimal Change Nephrotic Syndrome

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Kimura, Maiko, Graduate School of Medicine and School of Medicine, Chiba University, Chiba, CHIBA, Japan
  • Fujii, Takayuki, Seirei Sakura Citizen Hospital, Sakura city, Japan
  • Hiroaki, Tanaka, Seirei Sakura Citizen Hospital, Sakura city, Japan
  • Terasaki, Noriko, Seirei Sakura Citizen Hospital, Sakura city, Japan
  • Saito, Kaiji, Seirei Sakura Citizen Hospital, Sakura city, Japan
  • Suzuki, Satoshi, Seirei Sakura Citizen Hospital, Sakura city, Japan

Group or Team Name

  • Seirei Sakura Citizen Hospital
Background

KDIGO Guideline suggests that prednisolone (PSL) should be given at a single daily dose of 1 mg/kg, as initial treatment in adult-onset minimal change nephrotic syndrome (MCNS). However, there is no convincing evidence to support the guideline’s suggestion. It remains unclear how much the initial dose of PSL for MCNS should be given. On the other hand, from the viewpoint of side effects, the lower dose of PSL is fairly advantageous.

Methods

This retrospective cohort trial was performed in a single center between 1987 and 2017. Inclusion criteria were adult-onset MCNS diagnosed by kidney biopsy. These participants were classified into Low PSL group (L group, < 0.6 mg/kg), Moderate PSL group (M group, ≧ 0.6 mg/kg and < 0.8 mg/kg ) and High PSL group (H group, ≧ 0.8mg/kg). The primary outcomes of interest were time to first remission and first relapse of proteinuria. They were analyzed with ANOVA, log-rank test, and multivariate Cox proportional hazards models.

Results

A total of 58 patients were enrolled in this clinical trial. All of these patients at any dose of prednisolone achieved remission within a median of 16 (8-45) days in L group , 14 (6-166) days in M group , and 20 (8-37) days in H group . Long-rank test showed that there were no significant differences in the primary outcomes among three groups. Multivariate Cox proportional hazards revealed that although age (per 10 yr) and serum creatinine (per log 1mg/dl) were prognosis factors for the time to the first remission, PSL dose was not a significant factor (HR, 1.07; 95%CI, 0.43 to 2.79 (L group vs H group), 0.99 ; 95%CI, 0.41 to 2.44 (M group vs H group)). Additionally, multivariate Cox regression analysis for the incidence of relapse did not significantly indicate any prognostic factor.

Conclusion

Low or moderate doses of PSL are sufficient for initial treatment in adult-onset MCNS regarding the time to remission and incidence of relapse.