Corticosteroids for the initial episode of steroid-sensitive nephrotic syndrome

The International Study of Kidney Disease in Children (ISKDC) arbitrarily determined a standard-dose prednisolone regimen for the first episode of nephrotic syndrome [1]. This comprised 4 weeks of daily prednisolone (60 mg/m2/day; maximum dose 80 mg) followed by 4 weeks of prednisolone (40 mg/m2/day; maximum dose 60 mg) given on 3 consecutive days out of 7. After the Arbeitsgemeinschaft für Pädiatrische Nephrologie demonstrated in a randomized controlled trial (RCT) that alternate-day prednisolone therapy was more effective than intermittent doses of prednisolone in maintaining remission [2], alternate-day prednisolone dosing became the standard regimen for the second month of therapy. However, because of the high relapse rate with 2 months of prednisolone therapy, RCTs have investigated the benefits and harms of longer courses of therapy compared with 2 or 3 months.