Alternate-day Prednisolone Research Articles

Efficacy of zinc supplements in reducing relapses in steroid-sensitive nephrotic syndrome

Relapses in steroid-sensitive nephrotic syndrome (SSNS) often follow infections of the respiratory or gastrointestinal tract. Based on data that zinc supplements reduce the risk of infections, we examined the efficacy of such supplements in reducing relapse rates in these patients. Eighty-one patients with SSNS (1-16 years old) were stratified into frequent (n = 52) and infrequent (n = 29) relapsers and randomized to receive 12-months of therapy with the recommended dietary allowance of zinc (10 mg/day) (n = 40) or placebo (n = 41). Patients with frequent relapses also received long-term, alternate-day prednisolone. Subjects receiving zinc showed a 20% lower frequency of relapses, with 44.7% of the patients having sustained remission compared to 27.5% in the placebo group (P > 0.05). Patients with frequent relapses receiving zinc showed a 28% reduction in relapse rates and a significantly higher likelihood of sustained remission (P = 0.02). Findings from this double blind, randomized study suggest that zinc supplementation results in trends towards remission and reduced relapses, especially in patients with frequent relapses. Prospective, adequately powered studies are required for confirmation of these findings.

Efficacy and Safety of Tacrolimus Versus Cyclosporine in Children With Steroid-Resistant Nephrotic Syndrome: A Randomized Controlled Trial

To examine whether tacrolimus is more effective and safe than cyclosporine (CsA) in inducing remission in patients with steroid-resistant nephrotic syndrome (SRNS). Randomized controlled trial, nonblind, parallel group. Tertiary-care hospital; 41 consecutive patients with idiopathic SRNS, estimated glomerular filtration rate greater than 60 mL/min/1.73 m(2), and histological characteristics showing minimal change disease, focal segmental glomerulosclerosis, or mesangioproliferative glomerulonephritis were randomly assigned to treatment with tacrolimus (n = 21) or CsA (n = 20). Tacrolimus (0.1 to 0.2 mg/kg/d) or CsA (5 to 6 mg/kg/d) for 1 year; cotreatment with alternate-day prednisolone and enalapril. Patients achieving complete remission (urinary protein-creatinine ratio < 0.2 g/g and serum albumin > or = 2.5 g/dL) or partial remission (urinary protein-creatinine ratio, 0.2 to 2 g/g, and serum albumin > or =2.5 g/dL) at 6 and 12 months; time to remission; proportion with relapses; side effects. No patient was lost to follow-up. After 6 months of therapy, remission occurred in 18 (85.7%) and 16 patients (80%) treated with tacrolimus and CsA, respectively (relative risk [RR], 1.07; 95% confidence interval [CI], 0.81 to 1.41). Rates of remission at 12 months were also similar (RR, 1.14; 95% CI, 0.84 to 1.55). The proportion of patients who experienced relapse was significantly greater in those receiving CsA compared with tacrolimus (RR, 4.5; 95% CI, 1.1 to 18.2; P = 0.01). The decrease in blood cholesterol levels was greater with tacrolimus compared with CsA (difference in mean values, 45.1 mg/dL; 95% CI, 19.1 to 71.2). Persistent nephrotoxicity necessitating stoppage of medicine was seen in 4.7% and 10% patients, respectively. Cosmetic side effects (hypertrichosis and gum hypertrophy) were significantly more frequent in CsA-treated patients (P < 0.001). Single-center study, small sample size, and short duration of follow-up. Tacrolimus or CsA in combination with low-dose steroids show similar efficacy in inducing remission in patients with SRNS. Therapy with tacrolimus is a promising alternative to CsA in view of the lower risk of relapses and lack of cosmetic side effects.

Transition of children with membranoproliferative glomerulonephritis to adolescence and adulthood

Many chronic renal diseases in children, including membranoproliferative glomerulonephritis (MPGN), often continue into adulthood, and these patients require continuing management. Despite the importance of the topic, there has been limited discussion about the problems of transition in children with continuing renal disease. We report our experience in patients with MPGN, as they matured from childhood to adolescence and adulthood, so-called "carry-over" cases. The clinical course of diffuse MPGN in 27 children was retrospectively reviewed. Patients were over 18 years old at the end of follow-up. The mean follow-up period was 12.6 years; 20 children (74%) were identified by school urinary screening. The clinical course was favorable, and none of the patients progressed to end-stage renal failure during follow-up. However, eight patients (30%) continued to demonstrate proteinuria; two patients were nephrotic. Four patients were non-compliant and discontinued medication by themselves. Three patients were still on low dose of alternate-day (ALD) prednisolone. Twenty patients finished the treatment and were followed for an average of 4.6 years. Only one demonstrated trace amounts of proteinuria 1 year after discontinuing ALD prednisolone. MPGN often continues during maturation from childhood to adulthood, and patients are usually referred to adult nephrologists. Good communication between pediatric and adult nephrologists is important. In addition, more in depth explanation and reeducation about their disease and its management are helpful when these patients reach adolescence. These measures will improve their care and help to assure compliance with their medication regimen.

Revised guidelines for management of steroid-sensitive nephrotic syndrome.

Justification:In 2001, the Indian Pediatric Nephrology Group formulated guidelines for management of patients with steroid-sensitive nephrotic syndrome. In view of emerging scientific evidence, it was felt necessary to review the existing recommendations.Process:Following a preliminary meeting in March 2007, a draft statement was prepared and circulated among pediatric nephrologists in the country to arrive at a consensus on the evaluation and management of these patients.Objectives:To revise and formulate recommendations for management of steroid-sensitive nephrotic syndrome.Recommendations:The need for adequate corticosteroid therapy at the initial episode is emphasized. Guidelines regarding the initial evaluation, indications for renal biopsy and referral to a pediatric nephrologist are updated. It is proposed that patients with frequently relapsing nephrotic syndrome should, at the first instance, be treated with longterm, alternate-day prednisolone. The indications for use of alternative immunosuppressive agents, including levamisole, cyclophosphamide, mycophenolate mofetil, and cyclosporin are outlined. The principles of dietary therapy, management of edema, and prevention and management of complications related to nephrotic syndrome are described. These guidelines, formulated on the basis of current best practice, are aimed to familiarize physicians regarding principles of management of children with steroid-sensitive nephrotic syndrome.

Treatment with mycophenolate mofetil and prednisolone for steroid-dependent nephrotic syndrome

The management of patients with steroid-dependent nephrotic syndrome (SDNS) refractory to treatment with long-term steroids, levamisole and cyclophosphamide is difficult. We report our experience on long-term treatment with mycophenolate mofetil (MMF) and alternate-day prednisolone in 42 patients with SDNS previously treated with levamisole (n = 35) and/or cyclophosphamide (n = 37). The mean age (range) at onset of nephrotic syndrome was 37 (13-92) months and at treatment with MMF 104.7 (32-187) months. MMF was administered at a mean daily dose of 26.5 (16.6-31.3) mg/kg for 14.3 (6-45) months. The mean 6-monthly relapse rates decreased from 3.0 episodes before therapy to 0.9 episodes in the first 6 months, 0.7 in next 6 months, and 0.3 in those treated longer than 12 months (P < 0.0001). While on therapy, 32 (76.2%) patients showed 50% or more reduction in relapse rates, and nine (21.4%) had sustained remission. The cumulative dose of prednisolone declined significantly from 0.6 mg/kg per day before to 0.3 mg/kg per day while receiving MMF. Prednisolone requirement was reduced by 50% or more in 16 patients and between 40% and 50% in eight patients. Treatment continuation beyond 12 months resulted in sustained steroid sparing and reduced need for alternative treatments while maintaining low relapse rates. No patients had diarrhea, hematological abnormalities, or impaired renal function. This data confirms the efficacy and safety of treatment with MMF and tapering doses of alternate-day prednisolone in patients with SDNS and supports its use for longer than 12 months.

First Analysis of the Australasian Leukaemia and Lymphoma Group (ALLG) Trial of Thalidomide and Alternate Day Prednisolone Following Autologous Stem Cell Transplantation (ASCT) for Patients with Multiple Myeloma (ALLG MM6).

The therapeutic intervention with the greatest impact on survival prolongation for patients with multiple myeloma (MM) is high-dose chemotherapy with ASCT. Unfortunately, relapse is inevitable, thus the identification of strategies that prolong response duration is required. Glucocorticoids are a major component of MM therapy and randomized data suggest that they also have a role in response maintenance following conventional chemotherapy. Thalidomide (T) is effective in both de novo and relapsed MM and synergizes with glucocorticoids at low doses without relevant myelotoxicity. Based on these observations a randomized trial of T combined with maintenance alternate day prednisolone (AP) (ARM 1) vs AP (ARM 2) following ASCT was conducted. Inclusion criteria included age >18 years, non-progressive MM with a maximum of 12 months prior therapy, ECOG <3 and a serum creatinine <2mg/dl. Patients were stratified by transplant centre and pre-ASCT B2microglobulin (B2M) level (<4mg/L versus 4+mg/L). Patients underwent a single ASCT conditioned with melphalan 200mg/m2. At 6 weeks post-ASCT they were re-evaluated and those with no evidence of disease progression were randomized to AP 50mg with or without T 200mg daily. T was limited to a maximum daily dose of 200mg and for a maximum duration of 12 months because of concerns related to toxicity, development of drug resistance and cost. AP was scheduled to continue until disease progression. Both agents could be dose-reduced (minimum doses of 50mg and 12.5mg for T and AP, respectively) in the event of toxicity. All patients received zoledronic acid 4mg IV every 28 days for osteolysis prophylaxis. The primary and secondary end-points of the trial were progression-free (PFS) and overall survival (OS) from the date of randomization, respectively. Analyses were on an intention-to-treat basis. Between January 2002 and March 2005 243 patients from 29 centers were randomized - ARM 1 114 and ARM 2 129. The arms were matched for patient and disease characteristics with a median age of 57 years (range, 26 to 74) and median B2M for both arms of 2.2mg/L. Median follow-up for both arms is 2 years. At the time of randomization 9% vs 11% of patients in ARM 1 and 2, respectively, were in CR (immunofixation negative). 64% of patients were able to complete 12 months of T at a median dose of 100mg. Neurological toxicities were more common in ARM 1 but there were no differences in thrombo-embolic or renal toxicities. Pre-ASCT B2M demonstrated a significant association (p = 0.032) with PFS (Hazard Rate = 1.89, 95% CI 1.05–3.37, for 4+mg/L vs <4mg/L). Post-ASCT ARM 1 demonstrated superior PFS (p = 0.0003). Estimates of PFS at 1, 2 and 3 years were 91% vs 69%, 63% vs 36% and 35% vs 25% for ARM 1 and 2, respectively. As yet no significant survival benefit has been observed although ARM 1 demonstrated superior OS at 2 and 3 years 90% vs 81% and 84% vs 75% (p = 0.1). We conclude that consolidation with low-dose thalidomide in combination with alternate day prednisolone maintenance is an effective and tolerable therapeutic approach that prolongs the duration of disease response following ASCT for MM.

Long-term follow-up of diffuse membranoproliferative glomerulonephritis type I

In Japan, the school urinary screening system facilitates early detection and treatment of membranoproliferative glomerulonephritis (MPGN) in childhood. The present study investigated the long-term prognosis in 19 children with diffuse MPGN type I who received steroid therapy. Before signs of glomerulonephritis were confirmed, all patients displayed abnormal urinalysis results, predominantly through school urinary screening. Treatment comprised a regimen of alternate-day prednisolone after steroid pulse or cyclophosphamide therapy, and follow-up was continued for 10-24 years. Excluding 1 patient on short-term therapy, 18 patients received long-term alternate-day prednisolone therapy for 4-12 years. Treatment was discontinued when amelioration was confirmed on renal biopsy. As of the last observation, urinary abnormalities and hypocomplementemia had disappeared in 15 patients, while mild proteinuria without hypocomplementemia remained in 4 patients. No patients required hemodialysis. Moreover, no severe adverse effects attributable to treatment were identified other than mild short stature. Early detection and therapy using pulse methylprednisolone followed by alternate-day prednisolone was thus confirmed as safe and useful for treating diffuse MPGN type I.

Mycophenolate mofetil and prednisolone therapy in children with steroid-dependent nephrotic syndrome

Background: A proportion of patients with steroid-dependent nephrotic syndrome (SDNS) experience frequent relapses despite long-term treatment with steroids, levamisole, or/and cyclophosphamide. We prospectively examined the efficacy of long-term therapy with mycophenolate mofetil (MMF) as a steroid-sparing agent in this group. Methods: Nineteen patients with a mean age of 99.1 months (95% confidence interval [CI], 85.3 to 113) who had previously undergone long-term therapy with prednisolone (n = 19), levamisole (n = 16), and cyclophosphamide (n = 15), but had continued to show steroid dependence over many years, were studied. Renal biopsy showed minimal change disease and focal segmental glomerulosclerosis in 10 and 3 patients, respectively. Patients were administered MMF at a mean dose of 29 mg/kg/d (95% CI, 27.4 to 30.7) in 2 divided doses and decreasing doses of alternate-day prednisolone for a mean of 11.8 months (95% CI, 11.4 to 12.2). Relapses were treated with daily prednisolone until remission, with tapering later. They were additionally followed up for a mean of 17 months (95% CI, 15.9 to 18.1). Results: Mean relapse rates decreased from 6.6 (95% CI, 5.4 to 7.7) to 2 episodes/y (95% CI, 1.2 to 2.7) during MMF treatment (P < 0.0001). Four patients each had 0, 1, 2, and 3 relapses; failure of MMF therapy (>3 relapses during treatment) was seen in 3 patients. Treatment with MMF resulted in steroid sparing, with a reduction in mean prednisolone dose from 0.7 (95% CI, 0.6 to 0.8) to 0.3 mg/kg/d (95% CI, 0.2 to 0.4; P < 0.0001). Fourteen patients showed a 50% or greater reduction in relapse rates; prednisolone therapy could be discontinued for 6 or more months in 8 patients. No significant gastrointestinal or hematologic side effects of MMF treatment were noted. After discontinuation of MMF treatment, 68.4% of patients had an increased frequency of relapses and recurrence of steroid dependence, requiring treatment with other medications. Conclusion: Long-term therapy with MMF results in significant steroid sparing and reduction in relapse rates in patients with SDNS. Therapy with MMF and tapering doses of prednisolone appears to be a promising intervention in children with SDNS.

Focal segmental membranoproliferative glomerulonephritis in children.

Eight patients with focal segmental membranoproliferative glomerulonephritis (FSMPGN) were followed for 5-16 years. Their urinary abnormalities were detected by school urinary screening in seven, and one patient presented with nephrotic syndrome. All but one patient were treated with alternate-day (ALD) prednisolone. With time, urinalysis became normal in six and two continued to have proteinuria with or without hematuria. Serum albumin, cholesterol, and creatinine levels were normal at the last follow-up. Serum C3 returned to normal levels in six, but remained persistently decreased in two. Mesangial proliferation and matrix changes in glomeruli without MPGN lesions were mild. Subendothelial and mesangial electron-dense deposits and deposits containing C3 along capillary walls and mesangium were observed. MPGN lesions and mesangial proliferation improved. No severe growth retardation was observed, but the duration and dosage of ALD prednisolone could be reduced further, since the patients with FSMPGN seemed to have an excellent prognosis.

Long-term follow-up of type II membranoproliferative glomerulonephritis in two children

We report the long-term follow-up of two patients with type II membranoproliferative glomerulonephritis (MPGN). One Patients was treated with high-dose alternate-day prednisolone and the other with dipyridamole. Both had favorable clinical courses over 8.5 and 15.5 years of follow-up, respectively. One patient who showed diffuse proliferative changes lost the urinary abnormalities 2 years after starting treatment. Her follow-up renal biopsies showed histological improvement. In the other patient, a boy, renal biopsy performed 6 years after the onset showed mild mesangial proliferation and a moderate matrix increase. His urine became normal 14 years after onset. Intramembranous electron-dense deposits persisted in these patients over 7 and 6 years of observation, respectively. Patients with type II MPGN are usually difficult to treat and often progress to endstage renal failure. There is, however, a group of patients who have a favorable clinical course.

Relapse of ocular symptoms after remission of myasthenia gravis—a comparison of relapsed and complete remission cases

Extended thymectomy and high-dose alternate-day prednisolone administration may increase the chance of remission in myasthenia gravis (MG) patients. In cases of remission, ocular symptoms sometimes reappear after a gradual decrease or discontinuation of prednisolone administration. We compared relapsed patients with those who experienced complete remission. We found that the period from onset of MG to thymectomy and initiation of prednisolone administration was longer in the relapsed cases, which suggests that early thymectomy and administration of prednisolone can lead to a superior outcome in MG patients.

A Study of Membranoproliferative Glomerulonephritis in Iran

The aim of this study was to review the morphologic patterns of membranoproliferative glomerulonephritis (MPGN) in 100 Iranian patients using light microscopy (LM) and electron microscopy (EM), and to compare the treatment and outcome in 13 patients with two biopsies. A retrospective study of 713 kidney biopsies of Iranian patients received between 1981 to 1994 was carried out. Of the 713 kidney biopsies, MPGN (n=106) and membranous glomerulopathy (n=112) made up the highest numbers of cases. Among 100 MPGN patients, 55 (55%) were MPGN type I, 10 were type II (10%), and 35 type III (35%). Eighty-three (83%) had nephrotic proteinuria, 39 (39%) had hematuria, and 52 (52%) were hypertensive. Complement levels were estimated in 58, with low C3 in 10. The glomerular involvement was irregular, with focal hypercellularity in 47 patients (47%), widely patent capillaries in 50 (50%), arteriosclerosis in 48 (48%), and with hyaline change in 25 (25%). Follow-up data (22-130 months) was available in 61 (61%) patients: 6 (10%) died after 14-56 months, 27 (44%) were on maintenance hemodialysis for 15-110 months, and three received transplants. Thirteen patients had detailed follow-up and a second biopsy after 24-120 months. All 13 presented with edema and nephrotic range proteinuria, with hematuria and hypertension in five and azotemia in four. Seven of the 13 patients received initial steroids, followed by antiplatelet or antihypertensive drugs. Four (type III) patients received antiplatelet and antihypertension drugs, and two (type III) received only antihypertensive drugs. In the first biopsy, glomerular changes by light microscopy were non-uniform in 7 of 10 (70%) type III MPGN cases. Vascular changes were absent or mild in 11, and moderate in two. In the second biopsies, 10 showed decrease in cellularity, with many open capillaries, persistence of deposits by EM in all, and progression of vascular sclerosis in eight, and tubulointerstitial changes in 10. Among the 13, six were clinically stable, another six received dialysis followed by transplant in three, and one had relapses with episodes of cryoglobulinemia. Three patients died. There is a high incidence of MPGN in Iranian patients, with a substantial number of type III MPGN cases. Second biopsies showed decreased cellularity, but increase in chronic tubulointerstitial and vascular cases. Steroids did not appear to benefit the outcome in types I and III MPGN patients compared to patients who received antihypertensive and antiplatelet treatment without steroids.

Effect of alternate-day prednisolone administration on hypophyseal-adrenocortical activity in dogs

Abstract Objective To evaluate effect of alternate-day oral administration of prednisolone on endogenous plasma ACTH concentration and adrenocortical response to exogenous ACTH in dogs. Animals 12 Beagles. Procedure Dogs were allotted to 2 groups (group 1, 8 dogs treated with 1 mg of prednisolone/kg of body weight; group 2, 4 dogs given excipient only). During a 30-day period, blood samples were collected for determination of plasma ACTH and Cortisol concentrations before, during, and after treatment with prednisolone. From day 7 to 23, prednisolone or excipient was given on alternate days. Sample collection (48-hour period with 6-hour intervals) was performed on days 1, 7, 15, 21, and 28; on other days, sample collection was performed at 24-hour intervals. Pre-and post-ACTH plasma Cortisol concentrations were determined on days 3, 9, 17, 23, and 30. Results A significant difference was detected between treatment and time for group 1. Plasma ACTH concentrations significantly decreased for 18 to 24 hours after prednisolone treatment in group-1 dogs. At 24 to 48 hours, ACTH concentrations were numerically higher but not significantly different in group-1 dogs. Post-ACTH plasma Cortisol concentration significantly decreased after 1 dose of prednisolone and became more profound during the treatment period. However, post-ACTH Cortisol concentration returned to the reference range 1 week after prednisolone administration was discontinued. Conclusions and Clinical Relevance Single oral administration of 1 mg of prednisolone/kg significantly suppressed plasma ACTH concentration in dogs for 18 to 24 hours after treatment. Alternate-day treatment did not prevent suppression, as documented by the response to ACTH. (Am J Vet Res 1999;60:698–702)

Follow-up study of children with nephrotic syndrome treated with a long- term moderate dose of cyclosporine

Because of its potential for chronic nephrotoxicity, the long-term use of cyclosporine A (CsA) as treatment for nephrotic syndrome (NS) is controversial. The clinical outcome of patients with NS treated with CsA is unclear. We retrospectively evaluated 35 children with idiopathic NS, 24 with steroid-dependent NS (SDNS), and 11 with steroid- resistant NS (SRNS), who received CsA therapy for more than 12 months (median, 23 months) at the dosage maintaining 50 to 120 ng/mL in trough level. For SDNS patients, CsA was added to prednisolone after complete remission was achieved. For SRNS patients, CsA was used in combination with alternate-day prednisolone. Initial renal histology showed minimal changes (MC) in 28 patients (including all of the patients with SDNS) and focal segmental glomerulosclerosis (FSGS) in seven patients. The patients were followed up for 2 to 10.5 years (median, 6.5 years) after the termination of the CsA therapy. In SDNS patients, the relapse rate, dosage of prednisolone, standard deviation score for height, and body mass index significantly improved during CsA treatment. The follow-up study showed the proportion of SDNS decreased to 13 of 24 (54%) patients. In SRNS patients, CsA therapy induced remission in 8 of 11 patients (73%) (complete remission in seven and incomplete remission in one). Six of 11 patients (55%) then became steroid sensitive. Post- therapy biopsies, performed in 13 patients (10 with SDNS and three with SRNS), showed mild stripped interstitial fibrosis in two SDNS patients (15%). Long-term CsA therapy in moderate doses was effective to the patients with SDNS and SRNS and low in incidence of nephrotoxicity. The long-term use of CsA appears to result in a decrease in the proportion of SDNS and acquisition of subsequent steroid responsiveness in SRNS. (Am J Kidney Dis 1998 Jun;31(6):932-9)

The Medical Research Council Trial of Short-term High-dose Alternate Day Prednisolone in Idiopathic Membranous Nephropathy with Nephrotic Syndrome in Adults

We have assessed the medium-term effect of a short course of high-dose, alternate-day prednisolone on adult nephrotic patients with membranous nephropathy, using a randomized, prospective, double-blind, controlled trial. Patients were entered over the period 1981 to 1984 and were observed for a minimum of three years. One hundred and seven adult patients who had not previously received immunosuppressive treatment were included in the trial. One hundred and sixty further patients, excluded from the trial, but with membranous nephropathy were identified, followed and assesed retrospectively at the end of the trial. At 36 months there was no significant difference between control and treatment group in plasma creatinine, creatinine clearance or 24-h excretion of protein. At between three and six months serum albumin concentrations were higher and protein excretions lower in the treatment group compared to controls. No significant benefit was therefore observer on renal function in the medium term.

Serum Apolipoproteins A and B, Lecithin: Cholesterol Acyl Transferase Activities and Urinary Cholesterol Levels in Nephrotic Syndrome Patients before and during Steroid Treatment

Serum apolipoproteins A (Apo-A) and B (Apo-B) and lecithin: cholesterol acyl transferase (LCAT) activities and 24-hour urinary cholesterol levels were estimated in 25 nephrotic children before and during steroid treatment with 4 weeks of daily prednisolone followed by another 4 weeks of alternate-day prednisolone. The patients with untreated nephrotic syndrome (NS) showed significant decrease in serum Apo-A and LCAT activities associated with significant increase in serum Apo-B and urinary cholesterol levels compared to healthy controls (n = 25). Serum Apo-A levels correlated directly and Apo-B levels inversely with the serum albumin concentrations. After a transient elevation, the serum Apo-A level returned to control range by 8 weeks of treatment accompanied by a gradual increase in serum LCAT activity and decrease in urinary cholesterol excretion. Though, the serum Apo-B level was decreased with treatment, it was still significantly high compared to the controls.

High single-dose alternate-day corticosteroid regimens in treatment of polymyositis.

High single-dose alternate-day prednisolone therapy (ADT) was compared with daily-dose prednisolone therapy (DDT) for treatment of polymyositis. Thirty patients with polymyositis were treated with ADT for an average of 33.9 months. The combined number of improvements was 21 out of 30, a response rate of 70%. Side-effects were very rare and mild. On the other hand, 9 of 17 patients treated with DDT for an average 18.5 months improved, a response rate of 53%. The incidence of side-effects was strikingly higher than with ADT. ADT is therefore strongly advocated for treatment of polymyositis to avoid infectious complications and lessen cushingoid side-effects.

Growth After Renal Transplants

The growth of every child with a bone age less than 15 years who received a first renal transplant between 1975 and 1980 was analysed to determine the growth expectation of children with renal transplants substantially maintained on alternate-day prednisolone. Growth was expressed as a standard deviation score defined as the difference between the standard deviation for height at the time of the transplant and at the end of 1981. Average growth achieved by the 46 children. 41 with functioning transplants, was normal with a mean standard deviation score of +0.7 +/- 0.3 (SEM) for boys and -0.3 +/- 0.3 (SEM) for girls; 25 of the children had accelerated growth. Mean standard deviation scores per year of advance of bone age in 29 children was +0.003, which suggested no overall loss of growth potential. No difference in growth per year of advance in bone age was detected in children with a bone age less than 12 years at transplant compared with more mature children, but boys with a bone age less than 12 years grew better per year of advance in chronological age; this appeared to be related at least in part to their greater growth deficit at transplant. Glomerular filtration rate, alternate-day prednisolone dose, and level of plasma phosphate did not appear to affect growth in the 11 prepubertal children with functioning first grafts.

Growth after renal transplants.

The growth of every child with a bone age less than 15 years who received a first renal transplant between 1975 and 1980 was analysed to determine the growth expectation of children with renal transplants substantially maintained on alternate-day prednisolone. Growth was expressed as a standard deviation score defined as the difference between the standard deviation for height at the time of the transplant and at the end of 1981. Average growth achieved by the 46 children. 41 with functioning transplants, was normal with a mean standard deviation score of +0.7 +/- 0.3 (SEM) for boys and -0.3 +/- 0.3 (SEM) for girls; 25 of the children had accelerated growth. Mean standard deviation scores per year of advance of bone age in 29 children was +0.003, which suggested no overall loss of growth potential. No difference in growth per year of advance in bone age was detected in children with a bone age less than 12 years at transplant compared with more mature children, but boys with a bone age less than 12 years grew better per year of advance in chronological age; this appeared to be related at least in part to their greater growth deficit at transplant. Glomerular filtration rate, alternate-day prednisolone dose, and level of plasma phosphate did not appear to affect growth in the 11 prepubertal children with functioning first grafts.

Short-term efficacy and side effects of cloprednol in children with asthma.

Efficacy and safety of alternate-day prednisolone compared to single daily cloprednol were evaluated over a six-week period in 11 children with severe asthma requiring in-residence medical supervision and long-term corticosteroid therapy. Clinical indices of efficacy, including daily pulmonary symptom scores, number of asthma attacks, asthma severity scores, and bronchodilator usage, all favored cloprednol. Afternoon pulmonary function tests (FEV1, FVC, and PEFR) were all significantly improved during the cloprednol period. Although plasma cortisol values remained within the broad range of normal during the cloprednol period, mean values were consistent with partial pituitary-adrenal suppression similar in degree to that observed 24 hours after administration of an alternate-day program of prednisolone therapy. The results of this trial showed cloprednol in single daily doses to be more effective than prednisolone in alternate doses for the treatment of children with severe asthma.