Takehiko Yasaki

Intermittent versus long-term tapering prednisolone for initial therapy in children with idiopathic nephrotic syndrome

Forty-six children with steroid-responsive nephrotic syndrome were randomly allocated to receive two different prednisolone regimens for initial therapy. Twenty-nine children (group 1) received an intermittent regimen (60 mg/m2/day for 4 weeks, followed by 40/mg/m2/day on 3 days a week for 4 weeks); 17 children (group 2) had a long-term regimen (60 mg/m2/day for 4 weeks, followed by the same dose on alternate days for 4 weeks and the doses tapered by 10 mg/m2, given on alternate days every 4 weeks for 5 months). There was no difference between the two groups in the regimen used to treat relapses, steroid responsiveness, number of patients with relapses, and frequency of toxic reactions to steroids. However, the number of patients with a relapse within 6 months after initial therapy and the number of those with frequent relapses or steroid dependence were significantly higher in group 1 than in group 2 (P less than 0.05 for both). The data indicate that the long-term tapering regimen appears to be both safe and preferable to the intermittent regimen for initial therapy in children with idiopathic nephrotic syndrome.

Atrial fibrillation following methylprednisolone pulse therapy.

Two children, one with renal manifestations of systemic lupus erythematosus and the other with idiopathic nephrotic syndrome, were treated with methylprednisolone pulses. Neither had previous evidence of underlying cardiac disease. Within 24 h of pulse therapy, they complained of palpitations and developed atrial fibrillation which reversed spontaneously or after anti-arrhythmic therapy. Subsequent serial electro-and echocardiograms were normal. We propose that the arrhythmias were a complication of steroid pulse therapy.

Effect of corticosteroids on coagulation factors in children with nephrotic syndrome

Prothrombin time (PT), activated partial thromboplastin time (APTT) and plasma procoagulant activities were studied in 38 children with nephrotic syndrome in the presence or absence of prednisolone therapy. PT was normal but APTT was prolonged during relapse in untreated patients. Increased factors V, VII, VIII, XI and XIII in both treated and untreated and factor IX in treated patients, as well as decreased factors X and XII in untreated patients, were observed during relapse. These coagulation factor changes were unrelated either to the dose of prednisolone or underlying renal histology and normalized with clinical remission. However, plasma levels of factors II, V, VIII, IX, X and XI were still increased in treated patients. The data suggest that corticosteroids shorten APTT, raise both intrinsic and extrinsic factors, and therefore have favorable and unfavorable effects on the coagulation system in children with nephrotic syndrome.

Effect of Dipyridamole Treatment on Proteinuria in Pediatric Renal Disease

The effect of dipyridamole on proteinuria was studied in 60 children with various renal diseases. A significant decrease in 24-hour urine protein excretion was observed within a few months after treatment in 32 (53%) of the patients with minimal or moderate mesangial proliferation. The effect was reproducible and parallelled by a reduction in plasma levels of beta-thromboglobulin. Renal function in patients significantly improved with the therapeutical effect. The appropriate dosage was 4-10 mg/kg daily and no serious toxicity was seen despite large dosage and even in long-term application. The data suggest that dipyridamole treatment appears safe and has a beneficial effect on proteinuria dependent on its effect on platelets in renal disease.