Prolonged prednisolone treatment for the initial episode of childhood nephrotic syndrome may reduce relapse rate, butwhether this results fromthe increased duration of treatment or a higher cumulative dose remains unclear.We conducted a randomized, double-blind, placebo-controlled trial in 69 hospitals in The Netherlands. We randomly assigned 150 children (9 months to 17 years) presenting with nephrotic syndrome to either 3 months of prednisolone followed by 3 months of placebo ( n=74) or 6 months of prednisolone (n=76), and median follow-up was 47 months. Both groups received equal cumulative doses of prednisolone (approximately 3360 mg/m2). Among the 126 children who started trial medication, relapses occurred in 48 (77%) of 62 patients who received 3 months of prednisolone and 51 (80%) of 64 patients who received 6 months of prednisolone. Frequent relapses, according to international criteria, occurred with similar frequency between groups as well (45% versus 50%). In addition, there were no statistically significant differences between groups with respect to the eventual initiation of prednisolone maintenance and/or other immunosuppressive therapy (50% versus 59%), steroid dependence, or adverse effects. In conclusion, in this trial, extending initial prednisolone treatment from 3 to 6 months without increasing cumulative dose did not bene fit clinical outcome in children with nephrotic syndrome. Previous findings indicating that prolonged treatment regimens reduce relapses most likely resulted from increased cumulative dose rather than the treatment duration. Copyright

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Keywords Cushingoid syndrome, Netherlands, adolescent, age, albumin blood level, article, bone density, cataract, child, controlled study, diastolic blood pressure, double blind procedure, dyspepsia, female, follow up, gender, glaucoma, hematuria, human, immunosuppressive treatment, infant, maintenance therapy, major clinical study, male, meningitis, multicenter study, nephrotic syndrome, osteomyelitis, pertussis, pneumonia, preschool child, priority journal, randomized controlled trial, relapse, remission, school child, side effect, steroid therapy, stria, systolic blood pressure, thrombosis, treatment duration, treatment outcome, virus reactivation
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Journal American Society of Nephrology. Journal
Teeninga, N, Kist-Van Holthe, J.E, Rijswijk, N, de Mos, N.I, Wetzels, J.F.M, van der Heijden, A.J, … Hop, W.C.J. (2013). Extending prednisolone treatment does not reduce relapses in childhood nephrotic syndrome. American Society of Nephrology. Journal, 24(1), 149–159. doi:10.1681/ASN.2012070646