METHYLPREDNISOLONE PULSE THERAPY FOR NEPHROTIC SYNDROME

A two-year prospective study was conducted to evaluate the efficacy of methylprednisolone in 12 pediatric cases of nephrotic syndrome with dependency on or unresponsiveness to prednisone. Methylprednisolone boluses of 1g/1.73 m(2) in 5 % glucose solution (250 ml) were given intravenously. Each patient received six boluses on alternate days. Prednisone 2 mg/kg was given on the intermediate days. A response was achieved in the five patients with prior unresponsiveness to prednisone; histologic features in these patients ranged from membranous glomerulitis to mesangial proliferation. Six of the seven patients with dependency on prednisone achieved a complete remission. The remaining patient died. Caution is required when deciding whether to use methylprednisolone in a child with nephrotic syndrome. The risk of thromboembolism may be unacceptably high in patients with platelet counts above 400 000/mm(3) or severe hypoalbuminemia.