Multicentre Studies into treatment of Steroid sensitive nephrotic syndrome, on going.
Extended steroid course 16 vs 8 weeks. Randomised at 4/52. 60 to 40/m2 alternate days vs 60 alternate days tapering by 10 fortnightly. No significant difference in time to relapse (139 vs 87 days), frequent relapsers, or need for alternative immunosuppressive treatment.
50% of relapses provoked by URTI, and about 50% URTI result in relapse. Indian study 2011 gave daily pred for 7 days, reduced relapses by 0.7/yr.
So for relapsing steroid sensitive (2+ relapses in previous 12/12). Can be on immunosuppressants except cyclophosphamide or rituximab in previous 3/12. Must be on less than 15/m2. To get 6/7 daily pred 15/m2, to start within 24hrs of onset, or not. Randomised ahead of time at clinic, not at time of URTI. Def as 2 of fever, sore throat etc for 24hrs. Discuss with renal team or study hotline to check indications met.