Some clarifications while treating a child with Nephrotic syndrome:
[version 01]
- Which steroid should be used?
According to KDICO guidelines,
'Prednisone and prednisolone are equivalent, used in the same
dosage, and have both been used in RCTs depending on the country of origin’.
(Kidney International Supplements (2012) 2, 163–171)
Prednisolone has remained a reference drug. In Pakistan it is available as 5 mg tablets and 15mg/5ml suspension. Use plain (non-enteric coated) tablets as it is cheaper and has better absorption. Moreover the risk of gastro-intestinal bleeding due to steroids in ambulatory patients is 0.13% therefore; use of enteric coated prednisolone may not confer any additional
benefit.
(Consensus guidelines for the treatment of nephrotic syndrome in children of Pakistan. Department of Paediatric Nephrology, SIUT, page 2)
- Can we use dexamethasone, methylprednisolone etc in a child with nephrotic syndrome?
Yes, In most cases the steroid of choice is plain prednisolone tablets. Enteric coated forms can be used, however the bioavailability may decrease and there is additional cost with n o significant benefit. Other steroids like hydrocortisone, dexamethasone and deflazacort have been used in small trials with no significant benefit and hence not recommended.
If a child for any reason cannot swallow medications during acute illness then a nasogastric or oral tube can be used to administer Prednisolone. In rare cases Intravenous formulations can be given with following conversions.
(Consensus guidelines for the treatment of nephrotic syndrome in children of Pakistan. Department of Paediatric Nephrology, SIUT, page 11 & 12)
- Can we use of Antacids with Steroids?
It is customary to prescribe antacids with steroids. Aluminum containing antacids are known to decrease the absorption of steroids and H2 receptor blockers like ranitidine should be prescribed at a dose of 2 to 4 mg/kg /day to a maximum of 150 mg/day while proton pump inhibitors can be prescribed at 1mg/kg/day as once daily dose. Some authorities recommend using antacids only on as needed basis but physician treating this condition can take its own decision whether to add antacids or not. It must also be kept in mind that ranitidine may give false positive result for protein on “Multistic”.
(Consensus guidelines for the treatment of nephrotic syndrome in children of Pakistan. Department of Paediatric Nephrology, SIUT, page 2)
Some clarifications while treating a child with Nephrotic syndrome:
[version 02 will be uploaded on Monday, InshAllah)]