Multicentre Studies into treatment of Steroid sensitive nephrotic syndrome, on going.

PREDNOS1

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.

PREDNOS2

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.