Children with Steroid-resistant Nephrotic Syndrome:Long-term Outcomes of Sequential Steroid Therapy

Objective This study aimed to investigate the long-term outcomes in children with steroid-resistant nephrotic syndrome(SRNS), who received methylprednisolone pulse therapy(MPT)-based sequential steroid therapy. In particular, we aimed to observe whether these patients had a high risk of adverse events. Methods We conducted a retrospective study over a 5-year period. The long-term outcomes for children with SRNS receiving sequential therapy were observed. Results Sixty-three children were diagnosed with SRNS and underwent MPT-based sequential steroid therapy. Thirty-five(55.6%) achieved complete or partial remission, 19(30.2%) of whom were in remission even after treatment cessation at last review. The mean time to initial remission after MPT was 24.3±13.1 days. Forty-nine children(77.8%) experienced relapses, of whom 31(49.2%) demonstrated a frequent relapsing course. Adverse effects relevant to MPT were generally mild and infrequent. Five patients(7.9%) complained of vomiting or nausea during MPT infusion; 25(39.7%) experienced excessive weight gain and developed an obvious Cushingoid appearance; and 26(41.3%) had poor growth associated with long-term steroid use. Twenty-eight patients(44.4%) failed to respond to MPT, of whom 21(33.3%) achieved complete or partial remission with immunosuppressive agents. Conclusion MPT-based sequential steroid therapy appears to be a safe and effective method for inducing rapid remission in childhood SRNS. Further clinical studies are needed to comprehensively evaluate this therapy.