Paediatric nephrotic syndrome: prednisolone treatment adherence and short-term outcomes

Objective To analyse the outcomes of prednisolone treatment and adherence to treatment in paediatric-age patients diagnosed as having nephrotic syndrome. Methods A cross-sectional observational study was carried out for a period of 2 years. Data was collected retrospectively and patients were followed prospectively for adherence assessment. Children who had completed 1 year of prednisolone treatment from diagnosis of nephrotic syndrome were selected. The data was assessed for baseline demographics, clinical and laboratory findings, renal state, treatment and complications, as well as adherence to treatment. Results A total of 45 patients with paediatric nephrotic syndrome were analysed for 12 months, in which time 30 patients were adherent and 15 were non-adherent to the prednisolone regimen. A significant proportion of patients were male (male: female ratio of 1.8: 1). Cushingoid symptoms (66.6%) and hypertension (24.4%) were the most common side effects observed with prednisolone treatment. Upper respiratory tract infections were the most prevalent infections, observed in 31%. Non-adherence was observed in 33.3% of the patients according to the Morisky Assessment Scale. When compared to the adherent group a significant difference in terms of relapse rate was found, which lead to frequent hospitalisations. This may have some considerable cost burden on the parents. The most common reason for non-adherence was found to be a busy school schedule for the child, followed by symptoms resolving and the child feeling better. Conclusions Cushingoid symptoms and hypertension were the most common short-term side effects observed and a moderate level of adherence was found in study subjects. A busy school schedule for children was the most common reason cited for non-adherence by the patients/wards in our study. The relapse rate per patient in the non-adherent group was twofold higher than in the adherent group, signifying a need to improve adherence through intensive patient counselling and education.