Child Health/Steroids (childhood nephrotic)

Corticosteroids for nephrotic syndrome

also: prednisolone nephrotic · minimal change · steroid-responsive

Overview

Childhood nephrotic syndrome is usually minimal change disease and is highly steroid-responsive — high-dose oral prednisolone is first-line without needing a biopsy.

Mechanism

Glucocorticoid immunosuppression reduces the podocyte injury / glomerular protein leak of minimal change disease — ~80% are steroid-sensitive and remit. (See the Corticosteroids card for full mechanism + adverse effects.)

Indications

Childhood nephrotic syndrome (minimal change — first presentation)

The agents

Prednisolonehigh-dose then taper

60 mg/m²/day → taper

4 weeks then alternate-day taper; ~80% respond.

Steroid-sparing (ciclosporin/tacrolimus/cyclophosphamide)2nd line

Frequent relapses / steroid-dependent / steroid-resistant.

Adverse effects

Cushingoid features, growth suppression, hyperglycaemiaserious

See Corticosteroids card.

Infection risk (immunosuppression + immunoglobulin loss)serious

Pneumococcal vaccination; antibiotic prophylaxis if severe.

Relapse on weaningcommon

Cautions & contraindications

Live vaccines while heavily immunosuppressedpaediatric

Abrupt steroid withdrawalall

Adrenal suppression.

Interactions

As corticosteroids

Monitoring & kinetics

Urine protein (remission), BP, growth, glucose,Pneumococcal vaccination

Oral. Low-salt diet + diuretics for oedema; penicillin/albumin in selected severe cases.

Choosing it

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Source: BNF for Children — Corticosteroids · KDIGO — Nephrotic syndrome