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Abstract: SA-PO449

Adrenal Suppression After Prednisolone Treatment in Children with Idiopathic Nephrotic Syndrome: A Multicenter Prospective Study

Session Information

  • Pediatric Nephrology - II
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology


  • Harada, Ryoko, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
  • Kikunaga, Kaori, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
  • Kamei, Koichi, National Center for Child Health and Development, Tokyo, Japan
  • Hamada, Riku, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
  • Nagata, Hiroko, Kumamoto University, Kumamoto, Japan
  • Ando, Takashi, Tsukuba Gakuen hospital, Tsukuba, Japan
  • Ishikura, Kenji, National Center for Child Health and Development, Tokyo, Japan

Severe iatrogenic adrenal insufficiency can occur after steroid treatment. However, there have been a limited number of studies in adrenal insufficiency after prednisolone (PSL) treatment in children with idiopathic nephrotic syndrome (NS), despite much repeated use of PSL.


We prospectively obtained data of patients with NS aged 2 to 19 years who underwent PSL treatment using International Study of Kidney Disease in Children (ISKDC) regimen from September 2016 to August 2017 at two children’s hospitals in Tokyo. In the present study, adrenal insufficiency was defined as cortisol values less than 5 mcg/dL at 9 AM, based on our previous study in Kawasaki disease showing that single serum cortisol values less than 5 mcg/dL obtained at 9 AM from children treated with PSL were significantly correlated with peak serum cortisol value less than 15 mcg/dL in the corticotropin-releasing hormone stimulation test. Patients were divided into two groups and compared: an adrenal insufficient group (I) and a sufficient group (S) based on the serum cortisol values.


Ninety-eight children (70 boys) were enrolled and analyzed in this study: 12 (12.2%, 10 boys) were in the I group and 86 children (87.8%, 60 boys) were in the S group. The median serum cortisol value was 7.7 mcg/dL [IQR 6.9-15.1]. There was no statistically significant difference in age, period from final PSL administration to the cortisol measurement, or number of relapses between the two groups. The median dosage of PSL over one year up to the cortisol measurement day in the I group was significantly higher than that in the S group (3000 mg [778-5359] vs 0 mg [0-1395], p=0.004), and the number of children who experienced relapses during PSL treatment in the I group was also more than those of the S group (4/12 (33.3%) vs 8/86 (9.3%), p=0.038).


Adrenal suppression can occur in a significant proportion of children with NS treated with PSL. Care must be taken to avoid adrenal insufficiency in these children. A measurement of serum cortisol values after PSL treatment is necessary, particularly in those receiving high-dose steroid within a year.